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The impact and treatment of obesity and dyslipidaemias in renal transplantation

Purpose of reviewRenal transplant recipients have an increased risk of cardiovascular disease. Dyslipidaemia and obesity are complications of renal transplantation, in part a consequence of immunosuppressive agents. The link is established between elevated total and low-density lipoprotein cholesterol and risk of myocardial infarction following transplantation. In parallel with its increased prevalence in the general population, obesity has emerged as a major complication of transplantation. Recent evidence of the impact of dyslipidaemia and obesity on patient and graft survival is reviewed. Recent findingsThe Assessment of Lescol in Renal Transplantation study confirmed that statin therapy reduces risk of myocardial infarction but reinforced the notion that the natural history of cardiovascular disease in transplant recipients differs from the general population. An alternative therapeutic approach being investigated is modification of immunosuppression. Although the main reported complications of obesity are in the immediate postoperative period, obesity is linked (with hyperlipidaemia) to the development of the metabolic syndrome following transplantation and to increased risk of cardiovascular disease. SummaryHyperlipidaemia and obesity are complications of transplantation that adversely affect graft and patient survival. Future studies will address the relative benefits of modification of immunosuppression compared with additional therapy to treat these risk factors.