Lipid Profiles in Pediatric Thoracic Transplant Recipients are Determined by Their Immunosuppressive Regimens

Law, Yuk M.; Yim, Robert; Agatisa, Pat; Boyle, Gerard J.; Miller, Susan A.; Lawrence, Kathy; Webber, Steven A.

doi:10.1016/j.healun.2005.10.006

« Previous Next »The Journal of Heart and Lung Transplantation
Volume 25, Issue 3 , Pages 276-282, March 2006

Lipid Profiles in Pediatric Thoracic Transplant Recipients are Determined by Their Immunosuppressive Regimens

Yuk M. Law, MD
- Department of Pediatrics, Doernbecher Children’s Hospital, Oregon Health and Science University, Portland, Oregon
- Reprint requests: Yuk M. Law, MD, 707 SW Gaines Road, CDRC-P, Oregon Health and Science University, Portland, OR 97239. Telephone: 503-494-9899. Fax: 503-494-2824
Robert Yim, MD
- Department of Pediatrics, Doernbecher Children’s Hospital, Oregon Health and Science University, Portland, Oregon
Pat Agatisa, PhD
- National Childrens Medical Center, George Washington University, Washington, District of Columbia
Gerard J. Boyle, MD
- The Cleveland Clinic Foundation, Cleveland, Ohio
Susan A. Miller, MD
- Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
Kathy Lawrence, MN
- Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania
Steven A. Webber, CCHB
- Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, Pennsylvania

Received 31 May 2005; received in revised form 6 September 2005; accepted 5 October 2005. published online 06 January 2006.

Background

Controversy exists over the pattern of lipidemic effects from calcineurin inhibitors and prednisone. We report an extensive longitudinal study of lipid profiles in pediatric thoracic transplant recipients.

Methods

Serial fasting lipids of subjects from a single pediatric center, along with their immunosuppressive regimens, were examined. Groups were analyzed according to cyclosporine- or tacrolimus-based immunosuppression in addition to whether prednisone was used as adjunctive therapy.

Results

Of a total of 119 subjects, 85 were and remained on tacrolimus (TAC), 13 remained on cyclosporine (CSA), 4 switched from TAC to CSA, and 17 switched from CSA to TAC. The median age at transplant was 100 months, and the latest follow-up was 48 months. The CSA Group had higher lipid levels than the TAC Group, and levels changed minimally over time. At 1 year, TAC vs CSA total cholesterol was 153 vs 186 mg/dl (p = 0.002), low-density lipoprotein (LDL) cholesterol was 92 vs 117 (p = 0.09), and high-density lipoprotein (HDL) cholesterol was 42 vs 48 (p = NS), respectively. At the latest follow-up, the TAC vs CSA cholesterol was 143 vs 180 mg/dl (p = 0.001), LDL was 84 vs 115 (p = 0.001), and HDL was 42 vs 41 (p = NS). Profiles of subjects that switched agents reflected the agent used (e.g., higher total cholesterol, LDL, and HDL while on cyclosporine). Sub-group analysis showed prednisone augmented the hyperlipidemic effects.

Conclusion

Hyperlipidemia is common in pediatric thoracic transplant patients and persists over time. It is more pronounced in cyclosporine subjects and is further elevated with prednisone. These findings indicate the need for close monitoring, and consideration for intervention, especially in high-risk sub-groups.