Decreased postheparin lipolytic activity in renal transplant recipients with cyclosporin A

Abstract

The patterns of hyperlipidemia in renal transplant recipients (RTRs) are more variable than in the uremic state, showing increases in both very low-density lipoprotein (VLDL) and low density lipoprotein (LDL). This has been attributed, at least in part, to immunosuppressive therapy, especially to treatment with corticosteroids. Postheparin lipolytic activity (PHLA) was determined in 28 RTRs. Sixteen patients presenting with hyperlipidemia comprised group A, who were aged 49.8 ± 13.5 years, and had a cholesterol of 8.24 ± 1.86 mmol/liter, triglycerides of 6.02 ± 3.33 mmol/liter. Twelve patients presenting cholesterol and triglyceride values within the normal range were in group B, and were aged 48.6 ± 13.3 years. All RTRs received cyclosporin A (CsA) twice daily orally, which were divided in two equal doses and adjusted to provide CsA blood trough levels (RIA) in a range of 250 to 350 ng/ml. Twenty-one RTRs were additionally treated by alternate-day corticosteroids, whereas seven patients had CsA on their sole immunosuppressive agent. PHLA (μmol free fatty acids/ml/hr, given 10 and 20 min after 100 U/heparin kg body wt intravenously) was commonly reduced in RTRs (group A at 10/20 min: 5.6 ± 1.1/5.26 ± 1.2; group B: 8.26 ± 2.91/8.38 ± 3.44) as compared to the values obtained in healthy controls (15.3 ± 2.9/17.2 ± 5.0). This was mainly due to a reduction of the activity of the hepatic triglyceride lipase, and to a minor extent to a reduced activity of peripheral lipoprotein lipase. There was no statistically significant difference of PHLA in RTRs with or without corticosteroid treatment. Postheparin lipolytic activity is commonly decreased in renal transplant recipients. This effect does not depend on low corticosteroid administration, but may be caused by CsA medication.