Effects of cyclosporine-tacrolimus switching in posttransplantation hyperlipidemia on high-density lipoprotein 2/3, lipoprotein a1/b, and other lipid parameters.

OBJECTIVE: In renal transplant recipients, cyclosporine treatment appears to cause more frequent hyperlipidemia than tacrolimus usage. In this study, hyperlipidemic renal transplant recipients who use cyclosporine were investigated for changes in high-density lipoprotein (HDL)-2/3, apolipoprotein (Apo) A1/B, other lipid and biochemical parameters, and body mass index after prospective cyclosporine to tacrolimus switching. MATERIALS AND METHODS: Fifteen patients, including 9 females of overall mean age of 33.2 +/- 10.7 years and posttransplantation time of 78.06 +/- 42.93 months with a mean body mass index of 23.77 +/- 3.34 kg/m(2), were included if they were nondiabetic, hyperlipidemic, and had undergone renal transplantation between 1992 and 2000, using cyclosporine and candidates for a switch to tacrolimus due to hyperlipidemia. Before switching to tacrolimus and at 12 months of tacrolimus use we studied fasting blood samples for creatinine, uric acid, glucose, triglyceride, Apo A1, Apo B, low-density lipoprotein (LDL), HDL2, HDL3, and total cholesterol. RESULTS: There were no significant differences in creatinine, uric acid, glucose levels, or body mass index before tacrolimus versus 12 months thereafter. It was observed that tacrolimus significantly decreased triglyceride, Apo A1, Apo B, LDL, HDL, and total cholesterol levels (P < .001; P = .006; P = .01; P < .001; P = .03; P .05). CONCLUSION: Switching from cyclosporine to tacrolimus was associated with a more favorable cardiovascular risk profile by improving hyperlipidemia.

Doppler ultrasonography-guided surgery for high-flow hemodialysis vascular access: preliminary results.

AIM: We sought to investigate the results of flow reduction with prospective Doppler ultrasonography (USG)-guided surgery. PATIENTS AND METHODS: Thirty patients with end-stage renal failure with high-flow arterio-venous (AV) fistulae (n = 25) or AV grafts (n = 5) were included in the study. The indications for operation were as follows: cardiac failure (n = 18) or steal syndrome (n = 12). AV fistula flow >800 mL/min or AV graft >1200 mL/min was the selection criterion for definition of a high-flow vascular access. The desired postoperative flow was 400 mL/min or 800 mL/min for AV fistula or AV graft, respectively. Before the surgical intervention, a vascular clamp was used to simulate the planned intervention with evaluation by Doppler USG after the anastomosis was narrowed. RESULTS: There were 16 men and 14 women with a median age of 48 +/- 9 years (range, 39-57 years). Preoperative measurements of median AV fistula, AV graft flow, and anastomosis diameter were as follows: 2663 mL/min (range, 1856-3440 mL/min); 2751 mL/min (range, 2140-3584 mL/min); and 7.3 mm (range, 6.1- 8.5 mm), respectively. The flow was reduced to 615 mL/min (range, 552-810 mL/min) for AV fistulae and 805 mL/min (range, 745-980 mL/min) for AV grafts. The median diameter of the anastomosis was reduced to 4 mm (range, 3.5-4.3 mm). There were no reinterventions. During the median 1-year follow-up, AV fistula and AV graft patency rates were 100% and 80%, respectively and clinical complaints resolved. Cardiac output rate was reduced from 8.5 +/- 2.9 L/min to 6.1 +/- 1.9 L/min (P < .01). CONCLUSION: Cardiac failure and steal syndrome resulting from high-flow vascular access can be treated successfully with Doppler USG-guided surgery. The desired anastomotic diameter and flow are limited in cases of excessively dilated efferent veins for vascular access.