Author + information
- Received June 19, 1990
- Revision received February 14, 1991
- Accepted April 26, 1991
- Published online October 1, 1991.
- John A. Farmer, MDa,
- Christie M. Ballantyne, MD, FACCa,
- O.Howard Frazier, MD, FACC∗,
- Branislav Radovancevic, MD∗,
- Charlotte Payton-Ross, BAa,
- Wolfgang Patsch, MDa,
- Joel D. Morrisett, PhDa,
- Antonio M. Gotto Jr., MD, DPhil, FACCa and
- James B. Young, MD, FACCa,∗
- ↵∗Address for reprints: James B. Young, MD, 6565 Fannin SM 491, Houston, Texas 77030.
Although lipoprotein changes after cardiac transplantation have been documented, the effects of transplantation and subsequent immunosuppressive therapy (particularly the combination of prednisone, azathioprine and cyclosporine) on apolipoprotein levels and lipoprotein(a) have not been reported. Fasting cholesterol, triglycerides, high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol, apolipoprotein A-1 and B-100 and lipoprotein(a) were evaluated in 69 consecutive patients during the waiting period before cardiac transplantation.
There were 28 deaths before donor organ identification and 41 patients received a cardiac allograft. The lipoprotein levels of transplant recipients were again assayed 3 months postoperatively. Mean (± SEM) values increased for total plasma cholesterol (from 180 ± 8 to 228 ± 8 mg/dl, p ≤ 0.001), triglycerides (from 126 ± 11 to 207 ± 14 mg/dl; p ≤ 0.001), HDL cholesterol (from 39 ± 2 to 49 ± 3 mg/dl; p ≤ 0.002) and LDL cholesterol (from 119 ± 7 to 138 ± 7 mg/dl; p < 0.02). Apolipoprotein A-1 and B-100 also increased, but lipoprotein(a) decreased from 11.7 ± 1.7 to 6.8 ± 1.1 mg/dl; p ≤ 0.0001) after transplantation.
Although total cholesterol, triglycerides, LDL cholesterol, apoliprotein A-1 and B-100 increased dramatically after cardiac transplantation, so did HDL cholesterol, thereby keeping the LDL/HDL cholesterol ratio constant. The surprising decrease in lipoprotein(a) after cardiac transplantation suggests that metabolism of lipoprotein(a) is independent of LDL cholesterol and that immunosuppressive drugs either decrease the synthesis or increase catabolism of lipoprotein(a).
☆ This study was supported in part by the Cullen Trust for Health Care, Houston and by Grant HL 32971 from the National Heart, Lung, and Blood Institute, Bethesda, Maryland. Computational assistance was provided by the CLINFO project and funded by Grant RR-0035 from the Division of Research Resources, National Institutes of Health, Bethesda.
- Received June 19, 1990.
- Revision received February 14, 1991.
- Accepted April 26, 1991.