IS HOMOCYSTEINE AN IMPORTANT RISK FACTOR FOR THE TRANSPLANT RECIPIENT?

Abstract

313 Hyperhomocysteinaemia is widely recognised as an independent risk factor for the development of atherosclerotic cardiovascular disease. The aim of this study was to document plasma homocysteine levels in end-stage renal failure and sequentially following renal transplantation, and to correlate these findings with clinical outcome and renal function. As part of an ongoing study, homocysteine levels were measured in the plasma of cadaveric renal transplant recipients at baseline (n=87) and at follow-up of 3 months (n=62), 6 months (n=44) and 1 year (n=25). The samples were analysed by high performance liquid chromatography and a level of 16μmol/l was taken as the upper limit of normal. At each time point serum creatinine, albumin and drug trough levels were also assessed as was a urinary protein. An ultrasound-guided renal biopsy was performed and histological changes classified according to the Banff criteria. The homocysteine levels are summarised below: (Table)TableThere was a significant correlation between homocysteine and creatinine at 3 months, 6 months and 1 year (Pearson coefficients - 0.511, 0.37 & 0.616). There was no difference in homocysteine levels between individuals treated with tacrolimus (Prograf) or cyclosporin (Neoral) and there was no correlation between homocysteine and either age, sex, serum albumin, urinary protein, immunosuppressant trough levels or the development of histologically diagnosed chronic graft nephropathy. Whilst hyperhomocysteinaemia is a significant finding in the renal-failure population, the majority of patients with satisfactory function following renal transplantation have restoration of their plasma homocysteine towards the levels of the normal population, though this may take up to 1 year. We therefore conclude that homocysteine remains an important risk factor for the first year post-transplant year.