Avaliação dos lípides séricos em pacientes submetidos a transplante de rim-pâncreas ou pâncreas isolado e com enxertos funcionantes

Abstract

Background: Pancreas transplantation, when successful, restores glycemic control in diabetic patients with endocrine pancreatic failure. Pancreas-kidney transplantation also provides solution to chronic renal insufficiency. However, these proceedings require chronic use of immunosuppressive drugs. These are all factors that can modify the lipid profile of those patients. Objective: Study the lipid profile (total cholesterol-TC, triglycerides-TG, high density lipoprotein cholesterol-HDL-c, low density lipoprotein cholesterol-LDL-c and non HDL cholesterol-NHDLC) of patients with functioning pancreas-kidneytransplantation (PKT) or isolated pancreas transplantation (IPT), comparing data from one year (T1) and two years after transplantation (T2) to those at preoperatory (T0). Methods: Patients were submitted to transplantation at Felicio Rocho Hospital between 2002 and 2005. Patients with new onset diabetes after transplantation, patients with serum creatinine above 2 mg/dl and those in use of hypolipidemic or hypoglycemic drugs were excluded. All patients initially received the same immunosuppression protocol, based in the use of tacrolimus plus mophetil micophenolate and glucocorticoid. However, at the moment of analyze, almost 20% were not using glucocorticoid anymore. Alternatively, 5% were in use of sirolimus. Serum lipids, expressed in mean ± standard error, were analyzed using paired t. Student and a maximum p<0,05 was taken as significant. Results: 62 patients with PKT (45% female, 55% male, age=36.6±9.5 years) and 17 with IPT (47% female, 53 % male, age=34.8±9.9 years) were included. 53 patients (42 with PKT and 11 with IPT) completed two years of follow-up. Mean serum lipid levels of PKT group at T1 were lower than those at T0, except HDL-c. (TC= 208.1±7.5 x 176.4±5.0 mg/dl, p=0,0002; TG=142.0±8.0 x 110.8±7.6 mg/dl, p=0,003; LDL-c=131.1±6.8 x 106.7±4.6 mg/dl, p=0,0004; NHDL-c=161.4±7.0 x 129.0±4.8 mg/dl, p=0,0002; HDL-c=46.5±8.4 x 46.8±1.1 mg/dl, p=0,75). Similar results were found when data at T2 were compared to T0 in PKT group. (TC=215.5±9.6 x 169.9±5.3 mg/dl, p=0,0001; TG=153.5±9.4 x 102.3±15.2 mg/dl, p=0,01; LDL-c=136.9±9.2 x 100.3±4.1 mg/dl, p=0,0002; NHDL-c=170.3±9.1 x 121.9±5.3 mg/dl, p=0,0001; HDL-c=47.1±1.4 x 49.1±1.7 mg/dl, p=0,1). There werent any differences between data from T1 to T2. In IPT group, mean serum lipids of patients at T1 were similar to those at preoperatory, except lower HDL-c after transplantation. (TC=196.9±6.6 mg/dl x 182.2±13.4, p=0,29; TG= 93.5± 13.4 x 92.4±9.9 mg/dl, p=0,94; LDLc= 125.7±6.0 x 114.6±12.2 mg/dl, p=0,34; NHDL-c=144.6±7.5 x 133.1±13.6 mg/dl, p=0,4; HDL-c=52.6±2.7 x 49.0±1.7 mg/dl, p=0,04). When data were compared between T0 and T2, there werent any differences. (TC=197,3 ± 9,0 x187,0±15,0 mg/dl, p=0,86; TG=90,3±8,5 x 91,9±11,4 mg/dl, p=0,86; LDLc= 127,2±8,9 x 117,3±13,6 mg/dl, p=0,35; NHDL-c=145,5±10,0 x 137,5±15,3 mg/dl, p=0,45; HDL-c=52,3±3,0 x 50,2±2,5 mg/dl, p=0,27). Also in this group, there werent any differences between data from T1 to T2. Conclusion: On the two year follow-up of patients with functioning PKT, improvements in the serum lipids after transplantation were observed. However, the only difference seen in the lipid profile of patients submitted to IPT was a transitory fall in HDL-c. Serum lipids remained stable between one and two years of follow-up in both groups.