Liver transplant recipients have an increased risk for cardiovascular disease
because of a high incidence of obesity, arterial hypertension, diabetes mellitus,
and hyperlipidemia. Hyperhomocysteinemia has been found to be an important risk
factor for cardiovascular disease in large studies. Fasting serum levels of
homocysteine were measured in 105 liver transplant recipients, and
hyperhomocysteinemia was defined as a fasting serum homocysteine level greater
than 13 micromol/L. Patients with versus without hyperhomocysteinemia were
compared. The possible association of hyperhomocysteinemia with age, sex, cause
of liver disease, time elapsed since liver transplantation, immunosuppressive
therapy, folic acid level, liver function test results, renal function, and other
cardiovascular risk factors was investigated. Patients with serum homocysteine
levels greater than 15 micromol/L were treated with folic acid, 10 mg/d, and
serum homocysteine levels were measured again 1 to 3 months later in 10 patients.
Hyperhomocysteinemia was detected in 28 patients (27%). In univariate analysis,
it was associated with hepatitis C virus infection, treatment with mycophenolate
mofetil, and greater serum levels of alkaline phosphatase, gamma-glutamyl
transpeptidase, urea, and creatinine. In multivariate analysis, only greater
serum levels of creatinine (P =.006) were associated with hyperhomocysteinemia.
Treatment with folic acid resulted in a decrease in fasting serum homocysteine
levels in 9 of the 10 patients tested (P =.01). Hyperhomocystinemia, associated
with renal dysfunction, is a frequent finding in liver transplant recipients.
Treatment with folic acid may reduce fasting homocysteine levels
