Catalogo Articoli (Spogli Riviste)

OPAC HELP

Titolo:
Risk factors for and management of post-transplantation cardiovascular disease
Autore:
Fellstrom, B;
Indirizzi:
Univ Hosp, Dept Med Sci, SE-75185 Uppsala, Sweden Univ Hosp Uppsala Sweden SE-75185 Dept Med Sci, SE-75185 Uppsala, Sweden
Titolo Testata:
BIODRUGS
fascicolo: 4, volume: 15, anno: 2001,
pagine: 261 - 278
SICI:
1173-8804(2001)15:4<261:RFFAMO>2.0.ZU;2-J
Fonte:
ISI
Lingua:
ENG
Soggetto:
POSTTRANSPLANT DIABETES-MELLITUS; LEFT-VENTRICULAR HYPERTROPHY; LOW-DENSITY LIPOPROTEINS; SERUM TOTAL HOMOCYSTEINE; CORONARY-ARTERY DISEASE; ISCHEMIC-HEART-DISEASE; STAGE RENAL-DISEASE; MYCOPHENOLATE-MOFETIL; CYCLOSPORINE-A; LIVER-TRANSPLANTATION;
Tipo documento:
Review
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
136
Recensione:
Indirizzi per estratti:
Indirizzo: Fellstrom, B Univ Hosp, Dept Med Sci, SE-75185 Uppsala, Sweden Univ Hosp Uppsala Sweden SE-75185 SE-75185 Uppsala, Sweden
Citazione:
B. Fellstrom, "Risk factors for and management of post-transplantation cardiovascular disease", BIODRUGS, 15(4), 2001, pp. 261-278

Abstract

The mortality rates due to cardiovascular disease (CVD) in transplant recipients are greater than in the general population. CVD is a major cause of both graft loss and patient death in renal transplant recipients, and improving cardiovascular health in transplant recipients will presumably help toextend both patient and graft survival. Further studies are needed to better evaluate the effectiveness of risk modification on subsequent CVD morbidity and mortality. There is no reason to consider risk factors for CVD such as hyperlipidaemia. hypertension and diabetes mellitus in transplant recipients differently from in the general population. In addition, there are specific transplantation risk factors such as acute rejection episodes and the use of immunosuppressive drugs. It is obvious that several of the immunosuppressive agents used today have disadvantageous influences on risk factors for CVD such as hyperlipidaemia, hypertension and post-transplantation diabetes mellitus (PTDM), but the relative importance of immunosuppressant-induced increases inthese risk factors is basically unknown. This may be a strong argument forthe selective use and individual tailoring of immunosuppressive agents based upon the risk factor profile of the patient, without jeopardising the function of the graft. Hyperlipidaemia is common after transplantation. and immunosuppression with corticosteroids, cyclosporin, or sirolimus (rapamycin) causes different types of post-transplantation hyperlipidaemia. However, to date, no studies have demonstrated that lipid lowering strategies significantly reduce CVD morbidity or mortality and improve allograft survival in transplant recipients. Several studies using preventive or interventional approaches are ongoing and will be reported in the near future. Post-transplantation hypertension appears to be a major risk factor determining graft and patient survival, and immunosuppressive agents have different effects on hypertension. Controlled studies support the opinion that post-transplantation hypertension must be treated as strictly as in a population with essential hypertension, diabetes mellitus, or chronic renal failure. As increasing numbers of immunosuppressive agents become available for use, we may be in a better position to tailor immunosuppressive therapy to theindividual patient, avoiding the use of diabetogenic drugs, drug combinations, or inappropriate doses in patients susceptible to PTDM. Multiple acute rejection episodes have also been demonstrated to be a riskfactor for CVD - a strong argument for the use of immunosuppressive drugs to reduce acute rejection. Until we have a better understanding from ongoing landmark studies on the management of CVD, presently available therapy to reduce risk factors needsto be used together with individual tailoring of immunosuppressive therapywith the aim of reducing CVD in these patients.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 21/09/20 alle ore 11:23:33