Lipid abnormalities in stable liver transplant recipients – effects of cyclosporin, tacrolimus, and steroids

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Abstract
Dyslipidemia is common after liver transplantation, but the underlying mechanisms are largely unknown. We studied the lipid profile of 27 liver transplant recipients randomized to receive either cyclosporin (CyA, n= 14) or tacrolimus (n= 13) and compared them with 20 healthy, matched controls. Before transplantation, patients presented low total and low‐density lipoprotein (LDL) cholesterol (as compared to controls) that increased shortly, i.e., 3 months, after transplantation. Eighteen months post‐transplantation, total and LDL cholesterol levels decreased to pre‐transplant values but tended to remain higher in CyA‐treated patients. However, at that time, prednisone treatment was more prevalent among CyA‐treated than tacrolimus‐treated patients and fully accounted for the difference in cholesterol levels. Indeed, regardless of therapy, patients not receiving prednisone exhibited lower cholesterol levels than prednisone‐treated patients and controls. We conclude that prednisone therapy, rather than CyA or tacrolimus immunosuppression, seems to be the major determinant of increased cholesterol levels.