The triglyceride to HDL-cholesterol ratio and chronic graft failure in renal transplantation

Josephine L.C Anderson,Stephan J.L Bakker,Uwe J.F Tietge

doi:10.1016/j.jacl.2021.01.009

Abstract

BackgroundTransplant vasculopathy (TV) is a major contributing factor to chronic graft failure in renal transplant recipients (RTR). TV lesions resemble atherosclerosis in several ways, and it is plausible to believe that some risk factors influence both atherosclerotic plaque formation and formation of TV. ObjectiveThe objective of this prospective longitudinal study was to determine if dyslipidemia reflected by the triglyceride (TG)/high-density lipoprotein cholesterol (HDL-C) ratio is prospectively associated with death censored chronic graft failure in RTR. Method454 prospectively included RTR with a functioning graft for at least one year, were followed for a median of 7 years. RTR were matched based on propensity scores to avoid potential confounding and subsequently the association of the TG/HDL-C ratio with the endpoint chronic graft failure, defined as return to dialysis or re-transplantation, was investigated. ResultsLinear regression analysis showed that concentration of insulin, male gender, BMI and number of antihypertensives predict the TG/HDL-C ratio. Cox regression showed that the TG/HDL-C ratio is associated with chronic graft failure (HR = 1.43, 95%CI = 1.12–1.84, p = 0.005) in competing risk analysis for mortality. Interaction testing indicated that the relationship of the TG/HDL-C ratio with graft failure is stronger in subjects with a higher insulin concentration. ConclusionOur results demonstrate that the TG/HDL-C ratio has the potential to act as a predictive clinical biomarker. Furthermore, there is a need for closer attention to lipid management in RTR in clinical practice with a focus on triglyceride metabolism.

Highlights

Renal transplantation is the gold standard treatment for end-stage renal disease (ESRD)
Linear regression analysis showed that concentration of insulin, male gender, Body mass index (BMI) and number of antihypertensives predict the TG/high-density lipoprotein cholesterol (HDL-C) ratio
Cox regression showed that the TG/high-density lipoprotein (HDL)-C ratio is associated with chronic graft failure (HR 5 1.43, 95%confidence interval (CI) 5 1.12–1.84, p 5 0.005) in competing risk analysis for mortality

Summary

Introduction

Renal transplantation is the gold standard treatment for end-stage renal disease (ESRD). In many countries the number of renal transplant recipients (RTR) is even surpassing that of haemodialysis patients.[1] Availability of donor kidneys is sparse, and patients often spend years on waiting lists, or depend on a sacrifice by a family member or friend in the form of a living donation. Protection of donor kidneys and improving long-term graft survival is a major clinical, as well as ethical, necessity. Short-term graft survival is steadily improving, chronic graft failure still represents an important clinical challenge, eventually resulting in return to haemodialysis or re-transplantation.[2]. In addition to the risk of graft failure, renal transplant recipients face an increased risk of atherosclerotic and other cardiovascular disease (CVD). Transplant vasculopathy (TV) is a major contributing factor to chronic graft failure in renal transplant recipients (RTR). TV lesions resemble atherosclerosis in several ways, and it is plausible to believe that some risk factors influence both atherosclerotic plaque formation and formation of TV

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