Post-transplant dyslipidemia: Mechanisms, diagnosis and management

Abstract

Post-transplant dyslipidemia is highly prevalent and presents unique management challenges to the clinician. The two major outcomes to consider with post-transplant therapies for dyslipidemia are preserving or improving allograft function, and reducing cardiovascular risk. Although there are other cardiovascular risk factors such as graft dysfunction, hypertension, and diabetes, attention to dyslipidemia is warranted because interventions for dyslipidemia have an impact on reducing cardiac events in clinical trials specific to the transplant population. Dyslipidemia is not synonymous with hyperlipidemia. Numerous mechanisms exist for the occurrence of post-transplant dyslipidemia, including those mediated by immunosuppressive drug therapy. Statin therapy has received the most attention in all solid organ transplant recipient populations, although the effect of proper dietary advice and adjuvant pharmacological and non-pharmacological agents should not be dismissed. At all stages of treatment appropriate monitoring strategies for side effects should be implemented so that the benefits from these therapies can be achieved. Clinicians have a choice when there is a conflict between various transplant society and lipid society guidelines for therapy and targets.

Keywords: Cholesterol; Dyslipidemia; Triglycerides; Statins; Immunosuppression

Core tip: Post-transplant dyslipidemia is highly prevalent in all solid organ transplant recipient populations. Guidelines for therapy are derived mostly from general population experiences, although the mechanisms for dyslipidemia due to immunosuppression are distinct and known. Statin therapy has understandably received the most attention in transplant populations but the potential efficacy of other therapeutic strategies should not be ignored.