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Lipid abnormalities after renal transplantation

Daniel C Brennan, MD, FACP
Krista L Lentine, MD, PhD
Section Editor
Barbara Murphy, MB, BAO, BCh, FRCPI
Deputy Editor
Albert Q Lam, MD


The pathogenesis of posttransplant atherosclerotic cardiovascular disease (ASCVD) most likely involves traditional and nontraditional risk factors. Although lipid abnormalities and CVD are common complications of kidney transplantation, a causal association of dyslipidemias with cardiovascular risk has not been proven in this patient population.

However, extrapolation from general population studies and some data in kidney transplant patients support the view that the assessment and treatment of dyslipidemias should be part of routine postrenal transplant care. Since immunosuppressive medications often cause secondary dyslipidemias, medication regimens should be individualized to minimize the competing risks of rejection and CVD. (See "Risk factors for cardiovascular disease in the renal transplant recipient".)

Due to the high incidence of atherosclerotic disease events in the renal transplant population, we and several national groups suggest that patients with kidney transplants should be considered to be in the highest ASCVD risk group with respect to risk factor management [1]. Renal transplantation should therefore be considered a coronary heart disease equivalent risk. The prevalence and ability to modify dyslipidemias therefore render lipid modification a potentially important intervention for improving outcomes after kidney transplantation [2,3].

This topic review will provide an overview of the causes and management of lipid abnormalities in an attempt to lower cardiovascular risk in renal transplant recipients. The evidence concerning other putative benefits of lipid-lowering therapy among renal transplant recipients, including preservation of renal function and lower acute rejection risk, will also be discussed [4-8].


Dyslipidemia is defined by elevated plasma total cholesterol, elevated low-density lipoprotein (LDL), elevated triglycerides, and/or low high-density lipoprotein (HDL), all factors that may contribute to the development of atherosclerosis. Dyslipidemia is a frequent complication prior to and after kidney transplantation, even when allograft function is normal or near normal.

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Literature review current through: Nov 2017. | This topic last updated: Jun 10, 2016.
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