The effect of immunosuppressive therapy on the lipid profile of kidney transplant patients: A single-center study

Abstract

Background: Post-transplant dyslipidemia is common and presents unique management challenges for nephrologists. The most important outcomes of post-transplant dyslipidemia treatment include preserving or improving allograft function and reducing cardiovascular morbidity and mortality. Aim: This study aims to assess the impact of immunosuppressive therapy on lipid profiles in kidney transplant patients Methods: This cross-sectional study was conducted at the Renal Transplant and Nephrology Center, Baghdad Medical City, over 15 months. A total of 51 kidney transplant recipients were enrolled, including 34 males (66.7%) and 17 females (33.3%), with an age range of 20 to 60 years and a male-to-female ratio of 2:1. Patient data, including age, gender, medical history (including drug history and pre-transplant dyslipidemia), date of kidney transplantation, donor type (related or unrelated), immunosuppressive regimen, renal function tests, fasting blood sugar, fasting lipid profile, urinalysis, body weight, body mass index (to exclude obese patients), and blood pressure, were recorded using pre-prepared data sheets. Dyslipidemia in kidney transplant recipients was diagnosed based on a fasting lipid profile obtained after 8–12 hours of fasting. Results: Among the 51 kidney transplant recipients, 25 patients were on cyclosporine A, 21 on tacrolimus, and five on sirolimus, in addition to mycophenolate mofetil and prednisolone. There were statistically significant differences in serum cholesterol, low-density lipoprotein (LDL), and triglyceride levels among kidney transplant recipients based on their immunosuppressive medication. However, no statistically significant differences were observed in serum high-density lipoprotein (HDL) and very low-density lipoprotein (VLDL) levels. The highest cholesterol, triglyceride, and LDL levels were observed in patients receiving sirolimus, followed by those on cyclosporine A. In contrast, the lowest levels of cholesterol, LDL, and triglycerides were found in patients on tacrolimus therapy. No statistically significant differences in serum lipid levels were observed between males and females, between patients older than 40 years and those younger than 40 years, or between individuals with and without diabetes mellitus. Patients were categorized based on the time since transplantation (one, two, three, four, or five or more years post-transplant), but no statistically significant differences in serum lipid levels were found based on the duration since transplantation. Conclusion: Cyclosporine and sirolimus may contribute to dyslipidemia. Among the immunosuppressive therapies studied, sirolimus was associated with the worst lipid profile, while tacrolimus was linked to a more favorable lipid profile compared to both sirolimus and cyclosporine.