Approaches to the treatment of hyperlipidemia in the solid organ transplant recipient

OBJECTIVE: To review the literature investigating increased lipid concentrations in transplant recipients and the use of lipid-lowering agents in this population. DATA SOURCES: Relevant articles were identified from a MEDLINE search using the terms transplantation, hyperlipidemia, immunosuppression, and therapy including diet, gemfibrozil, bile acid sequestrants, nicotinic acid, probucol, and hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors. Selected literature, including controlled studies, was used in this review. STUDY SELECTION: Articles published since 1970 pertaining to hyperlipidemia in solid organ transplant recipients. Emphasis was placed on clinical trials that investigated approaches to the treatment of hyperlipidemia in transplant recipients. DATA EXTRACTION: Original articles and reviews were obtained to select material pertinent to the objectives. DATA SYNTHESIS: Descriptions of lipid concentrations in the transplant patient and treatment approaches used, including potential complications, were reviewed. CONCLUSIONS: Hyperlipidemia is an important risk factor for coronary heart disease in the solid organ transplant patient. Treatment alternatives include diet modification and, in most cases, pharmacologic intervention that should be based on the type of hyperlipidemia. The HMG-CoA reductase inhibitors are effective agents in the treatment of hyperlipidemia in the transplant recipient and generally are used as single therapy in low dosages to minimize the risk of myositis or rhabdomyolysis.