The Adverse Impact of Cyclosporine on Serum Lipids in Renal Transplant Recipients

The extent to which cyclosporine (CsA) directly, or indirectly, influences serum lipid levels in renal transplant patients treated with multiple-drug immunosuppression protocols is unclear. Indeed, patients treated with CsA have reduced corticosteroid requirements, fewer acute rejection episodes, and other differences from patients receiving conventional immunosuppression that may reduce serum lipid levels. We studied patients treated with low-dose CsA, corticosteroids, azathioprine, and Minnesota antilymphocyte globulin ([ALG] n = 205) versus conventional (three-drug) immunosuppression (n = 368) and evaluated the impact of CsA, acute rejection episodes, and other clinical parameters on serum lipids. Fasting serum lipid levels from stable patients transplanted between 1976 to 1989 were studied at 3 (n = 573), 12 (n = 565), 26 (n = 55), and 52 (n = 521) weeks posttransplant using multivariate, linear regression analysis. The incidence of acute rejection episodes was reduced by CsA, but patients with fewer acute rejection episodes in the early posttransplant period had higher serum total cholesterol (increased by.33 ± .12 mmol/L [13 ± 5 mg/dL] and .27 ± .12 mmol/L [10 ± 5 mg/dL], P < 0.05, at 3 and 12 weeks, respectively) and low-density lipoprotein (LDL) (increased by .23 ± .11 mmol/L [9 ± 4 mg/dL] and .23. ± .11 mmol/L [9 ± 4 mg/dL], P<0.05). Compared with conventional immunosuppression, CsA caused 15% to 20% increases in total cholesterol (.77 to .92 mmol/L [30 to 36 mg/dL], P<0.05), LDL (.52 to .55 mmol/L [20 to 21 mg/dL], P<0.05), and triglycerides (.32 to 1.75 mmol/L [28 to 155 mg/dL], P<0.05) that could not be attributed to the reduction in acute rejection episodes, differences in renal function, or alterations in other clinical parameters associated with the use of CsA. Altogether, these results suggest that CsA has a direct, adverse effect on serum lipid levels in renal transplant recipients.