Dyslipidaemia after Heart Transplantation
Maria Simonenko1, Petr Fedotov2, Yulia Sazonova3, Vadim Rubinchik4, Tatiana Pervunina7, Maria Sitnikova2, German Nikolaev3, Mikhail Gordeev5, Mikhail Karpenko6.
1Heart Transplantation, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 2Heart Failure, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 3Thoracic Surgery and Transplantation Laboratory, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 4ICU 4, Almazov National Medical Research Centre, Saint-Petrsburg, Russian Federation; 5Cardiothoracic Surgery SRL, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 6Chairman of Scientific Clinical Council, Deputy Director for Science and Medical Work, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation; 7Children diseases, Almazov National Medical Research Centre, Saint-Petersburg, Russian Federation
Objective: to estimate the frequency of dyslipidaemia (DLP) and to determine the risks after heart transplantation (HTx).
Methods: From 2010 to 2017 we performed 96 HTx (mean age 46,5±13,9 yrs; n=5 – children, 15 [10;16] yrs old). All patients were divided into 2 groups according to causes of heart failure: ischemic heart disease (IHD) (50%, n=48) and others (50%, n=48). Before HTx 36,5% (n=35) of recipients had the level of cholesterol > 4,5 mmol/l. Before HTx 56% (n=27) of IHD recipients underwent CABG or stent-implantation. Before HTx coronary angiography (CAG) was performed in donors older than 40 yrs (51%, n=49). All recipients were treated with triple-drug therapy (steroids, calcineurin inhibitors, mycophenolic acid/everolimus), induction (basiliximab – 79%, thymoglobulin – 21%) and also by statins to treat or to prevent DLP. We estimated the results of lipid profile and frequency of DLP.
Results: In 6 months after HT the level of total cholesterol (TC) did not change in patients with IHD (4,5±1,2 and 4,9±1,1 mmol/l, p>0,05). However, it increased in recipients without IHD history (3,9±1,2 and 4,5±0,9 mmol/l, p<0,05). Despite of therapy by statins DLP took place in all children recipients. After HTx 11 patients continued smoking and had higher level of TC (6,1±2,1 mmol/l, p>0,05). Patients who treated with everolimus had worse DLP than those with mycophenolic acid (TC - 5,9±0,9 vs. 4,5±1,6 mmol/l, p<0,05; LDL – 3,4±1,2 vs. 2,1±1,0 mmol/l, p>0,05; triglycerides – 2,6±1,1 vs. 1,7±0,9 mmol/l, p>0,05). We found correlations between TC in non-IHD recipients and time in ICU (r=0,549; p<0,001), time spent on inotropes (r=0,539; p<0,001) and the age of donors (r=0,400; p<0,05).
Conclusion: DLP may occur in all heart transplanted patients, especially non-IHD ones need to take under control.
