Folate supplementation after heart transplantation: effects on homocysteine plasma levels and allograft vascular disease

Abstract

Background and aims: After heart transplantation, the effects of folate supplementation on total homocysteine plasma levels (THcy) and heart allograft vascular disease (AVD) remain unclear. Methods: Accordingly, we prospectively analyzed 48 heart transplant receipients referred for routine follow-up from July to September 1998 (age 54±11 years, 75% male, 35±27 months from transplant). Among these patients, 17 were treated with folate supplementation for 12 months (Group F), while 31 cross-matched for age, gender, serum creatinine and time from transplant (P>0.3 vs Group F for all) did not assume folate supplementation (Group NF). Routine coronary angiography for AVD detection was routinely obtained in every patient. Results: THcy overall increased during the study period (from 16.6±6.5 to 19.4±7.6 μmol/l, P<0.001), and a strong trend toward higher THcy was observed in patients presenting AVD (22.4±8.7 vs 17.6±6.8 μ mol/l, P=0.051). After 12 months THcy was lower in Group F as compared to Group NF (16.2±5.6 vs 21.1±8.1 μ mol/l, respectively, P=0.033). Conclusions: Our results demonstrate that THcy increases over time in heart transplant recipients, and a strong trend toward higher THcy is observed in the presence of AVD. Since folate supplementation appears to positively influence THcy, a favorable effect of folate on AVD can be hypothesized.