Dyslipidemia Can Be Controlled in Diabetic as well as Nondiabetic Recipients after Kidney Transplant

Abstract

Background Patients with diabetes have been reported to have greater dyslipidemia after kidney transplant (KTX). As post-KTX management of diabetes has changed dramatically since those reports, we hypothesized that lipids can be controlled as well in diabetic as nondiabetic recipients. Methods We compared lipids up to two years after KTX (n=192) between diabetic and nondiabetic recipients. The cohort was subdivided into non-diabetic (nonDM-K; n=123), type 2 (DM2-K; n=33), or type 1 diabetes after KTX (DM1-K; n=14), or type 1 after kidney-pancreas (DM1-KP; n=22). Results Mean age and BMI of DM2-K were greater than the others (p\u3c0.01), and diabetes groups had a higher pre-transplant A1C than nonDM-K (p\u3c0.001). After KTX, lipids were not greater in diabetic than nondiabetic recipients, and didn’t increase in any group. Total and LDL-cholesterol decreased in DM1-K (p\u3c0.001), HDL decreased in DM1-KP (p=0.02), and triglycerides were unchanged after KTX for all groups. A1C improved in DM1-K and DM1-KP (p\u3c0.0001). There was less improvement in lipids with tacrolimus-sirolimus immunosuppression than other steroid-containing regimens (p\u3c0.05). Conclusions Multiple mechanisms may contribute to better lipids in both groups as well as the lack of difference between diabetic and nondiabetic recipients compared to what has been reported previously: greater use of and more effective lipid lowering agents, no significant weight gain, no difference in renal function between groups, and better control of glucose in the diabetic group. Thus, overall, lipids can be controlled as well in diabetic as nondiabetic KTX recipients