Lipid abnormalities in pediatric kidney transplant recipients on steroid withdrawal maintenance immunosuppression

• Published in: Pediatric nephrology (Berlin, West) Vol. 39; no. 1; pp. 261 - 268
• Main Authors: Zangla, Emily, Mahajan, Ruchi, Jiang, Ziou, Kizilbash, Sarah J.
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.01.2024; Springer; Springer Nature B.V
• Subjects: Body mass index; Calcineurin; Cardiovascular diseases; Cholesterol; Complications and side effects; Corticosteroids; Demographic aspects; Diabetes mellitus; Diagnosis; Dosage and administration; Dyslipidemia; Dyslipidemias; Epidermal growth factor receptors; Heart; Hypertrophy; Immunosuppression; Immunosuppressive agents; Kidney transplantation; Kidney transplants; Kidneys; Lipids; Medicine; Medicine & Public Health; Metabolic disorders; Nephrology; Original Article; Patients; Pediatrics; Risk factors; Steroids; Transplantation; Urology; Ventricle; What’s New in Renal Transplantation; United States; Steroid withdrawal; Immunosuppression; Cardiovascular; Pediatric; Dyslipidemia; Kidney transplantation
• ISSN: 0931-041X; 1432-198X; 1432-198X
• DOI: 10.1007/s00467-023-06110-w

Background Dyslipidemia is a modifiable risk factor for cardiovascular disease. The prevalence of dyslipidemia in pKTR (pediatric kidney transplant recipients) under modern immunosuppression remains unknown. We determined the prevalence, risk factors, co-morbidities, and treatment patterns of lipid abnormalities in pediatric kidney transplant recipients on steroid withdrawal immunosuppression. Methods pKTR (age ≤ 21 years) at a single center on steroid withdrawal immunosuppression underwent lipid screening between January 1, 2020, and September 30, 2022. Continuous and categorical variables were compared using the Wilcoxon rank-sum and chi-square or Fisher’s exact tests, respectively. The correlation between total cholesterol and BMI (body mass index) was assessed using Pearson’s product–moment correlation, and predictors of lipid abnormalities were evaluated using the multivariable logistic regression. Results A total of 96 patients were included, with a median post-transplant time of 2.5 years (IQR: 1.3–5.4). Of the total, 64.6% ( n  = 62) of patients had a fasting lipid abnormality. We found a significant linear correlation between total cholesterol and BMI ( r  = 0.38, p  = 0.0022). After multivariable adjustment, every 1 ml/min/1.73 m 2 increase in eGFR was associated with a 2% lower odds of a lipid abnormality (OR 0.979, p  = 0.026). Obesity, hypertension, and left ventricular hypertrophy were similar between those with and without lipid abnormalities, while insulin-treated diabetes was more prevalent in recipients with lipid abnormalities (12.9% vs. 0%, p  = 0.047). Only 36.5% of patients ( n  = 19) were referred to a dietician and/or lipid specialist; one received statin therapy. Conclusions Lipid abnormalities are highly prevalent in pKTR, but therapeutic intervention is infrequent. Calcineurin inhibition without corticosteroids may not be protective; however, higher eGFR is associated with a lower prevalence of lipid abnormalities. Graphical abstract A higher resolution version of the Graphical abstract is available as Supplementary information