title: HDL Cholesterol Efflux Predicts Graft Failure in Renal Transplant Recipients.
abstract: High-density lipoprotein (HDL) particles are involved in the protection against cardiovascular disease by promoting cholesterol efflux, in which accumulated cholesterol is removed from macrophage foam cells. We investigated whether HDL cholesterol efflux capacity is associated with cardiovascular mortality, all-cause mortality, and graft failure in a cohort of renal transplant recipients (n=495, median follow-up 7.0 years). Cholesterol efflux capacity at baseline was quantified using incubation of human macrophage foam cells with apolipoprotein B-depleted plasma. Baseline efflux capacity was not different in deceased patients and survivors (P=0.60 or P=0.50 for cardiovascular or all-cause mortality, respectively), whereas recipients developing graft failure had lower efflux capacity than those with functioning grafts (P<0.001). Kaplan-Meier analysis demonstrated a lower risk for graft failure (P=0.004) but not cardiovascular (P=0.30) or all-cause mortality (P=0.31) with increasing gender-stratified tertiles of efflux capacity. Cox regression analyses adjusted for age and gender showed that efflux capacity was not associated with cardiovascular mortality (hazard ratio [HR], 0.89; 95% confidence interval [95% CI], 0.67 to 1.19; P=0.43). Furthermore, the association between efflux capacity and all-cause mortality (HR, .79; 95% CI, 0.63 to 0.98; P=0.031) disappeared after further adjustment for potential confounders. However, efflux capacity at baseline significantly predicted graft failure (HR, 0.43; 95% CI, 0.29 to 0.64; P<0.001) independent of apolipoprotein A-I, HDL cholesterol, or creatinine clearance. In conclusion, this prospective study shows that cholesterol efflux capacity from macrophage foam cells is not associated with cardiovascular or all-cause mortality but is a strong predictor of graft failure independent of plasma HDL cholesterol levels in renal transplant recipients.
authors: Department of Pediatrics, Center for Liver, Digestive, and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Top Institute Food and Nutrition, Wageningen, The Netherlands;
authors: Wijtske
authors: W
authors: Annema
authors: Department of Pediatrics, Center for Liver, Digestive, and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;
authors: Arne
authors: A
authors: Dikkers
authors: Department of Pediatrics, Center for Liver, Digestive, and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands;
authors: Jan Freark
authors: JF
authors: de Boer
authors: Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; and.
authors: Robin P F
authors: RP
authors: Dullaart
authors: Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: Jan-Stephan F
authors: JS
authors: Sanders
authors: Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors: Stephan J L
authors: SJ
authors: Bakker
authors: Department of Pediatrics, Center for Liver, Digestive, and Metabolic Diseases, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Top Institute Food and Nutrition, Wageningen, The Netherlands; u_tietge@yahoo.com.
authors: Uwe J F
authors: UJ
authors: Tietge
mesh_terms: D001692:Biological Transport; D008076:Cholesterol, HDL / Q000097:blood* / Q000378:metabolism; D005260:Female; D005487:Foam Cells / Q000378:metabolism; D006801:Humans; D016030:Kidney Transplantation; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017211:Treatment Failure
chemical_list: D008076:Cholesterol, HDL
keywords: arteriosclerosis; chronic allograft failure; lipids; mortality; transplant outcomes