Hyperlipidemia in Children After Heart Transplantation

Background: Long-term outcome after cardiac transplantation is limited by graft coronary vasculopathy (GCV). Hyperlipidemia may contribute to the development and progression of GCV. The purpose of this study was to determine the distribution of lipid levels in children after heart transplantation and to determine the incidence and risk factors for hyperlipidemia. Methods: We compared the distribution of lipid values 1 year after heart transplantation in children participating in Pediatric Heart Transplant Study to those of normal U.S. children and then performed a multivariable analysis to identify risk factors for hyperlipidemia. Results: The median values of total and LDL-cholesterol in heart transplant patients were similar to those of normal U.S. pediatric population. However, total cholesterol level was >200 mg/dl in 14% and >170 mg/dl in 33% of transplant patients. LDL-cholesterol was >130 mg/dl in 12%, >110 mg/dl in 27% and >100 mg/dl (greater than "optimal" levels) in 39% of transplant patients. The distribution curve for serum triglycerides was shifted to the right and that for HDL-cholesterol levels was shifted to the left of the normal U.S. pediatric curve. As a result, triglyceride levels were >75th centile of U.S. normal distribution in 59% of the transplant patients. HDL-cholesterol level was <25th centile of U.S. normal distribution in 61% of the transplant patients. Independent risk factors for elevated levels of total and LDL-cholesterol were patient age and use of cyclosporine and prednisone. Conclusions: Lipid levels considered to be in the intervention range in adults at high risk of coronary artery disease are a common finding after cardiac transplantation in children.