Dialysis – Transplantation

Kidney International (2005) 67, 2046–2055; doi:10.1111/j.1523-1755.2005.00307.x

Insulin resistance, LDL particle size, and LDL susceptibility to oxidation in pediatric kidney and liver recipients

ARJA SIIRTOLA, MARJATTA ANTIKAINEN, MARJA ALA-HOUHALA, ANNA-MAIJA KOIVISTO, TIINA SOLAKIVI, SUVI M VIRTANEN, HANNU JOKELA, TERHO LEHTIMÄKI, CHRISTER HOLMBERG and MATTI K SALO

Paediatric Research Centre, University of Tampere, Tampere, Finland; Hospital for Children and Adolescents, University of Helsinki, Helsinki, Finland; Department of Pediatrics, Tampere University Hospital, Tampere, Finland; University of Tampere, Tampere School of Public Health, University of Tampere and Tampere University Hospital, Research Unit, Tampere, Finland; The Center of Laboratory Medicine, Department of Clinical Chemistry, Tampere University Hospital, Tampere, Finland; University of Tampere, Medical School, University of Tampere, Tampere, Finland; and Unit of Nutrition, Department of Epidemiology and Health Promotion, National Public Health Institute, Helsinki, Finland

Correspondence: Arja Siirtola, University of Tampere, Paediatric Research Centre, FIN-33014, University of Tampere, Finland. E-mail:arja.siirtola@uta.fi

Received 14 April 2004; Revised 26 June 2004; Re-revised 26 September 2004; Re-revised 15 November 2004; Accepted 13 December 2004.

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Abstract

Insulin resistance, LDL particle size, and LDL susceptibility to oxidation in pediatric kidney and liver recipients.

Background

 

Dyslipidemia is common after solid organ transplantation. We have described hypertriglyceridemia in about 50% of our pediatric kidney, and in about 30% of our liver recipients. The aim of the present study was to find out whether this post-transplantation hypertriglyceridemia after pediatric solid organ transplantation is associated with insulin resistance and the occurrence of small, dense low-density lipoprotein (LDL).

Methods

 

Fifty kidney and 25 liver recipients (aged 4 to 18 years) on triple immunosuppression, and 181 control children participated in the study for an average of 5.3 and 6.4 years after kidney and liver transplantation (range 1 to 11 years), respectively. Homeostasis model assessments for insulin resistance (HOMA) were calculated and fasting lipoprotein lipid profile, apolipoprotein A-I and B concentrations, LDL particle diameter, and indices of LDL susceptibility to copper-induced oxidation determined.

Results

 

Kidney patients had significantly higher serum total, high-density, and low-density lipoprotein cholesterol, triglyceride, apolipoprotein A-I and B concentrations than liver patients or control subjects (P < 0.003 for all). HOMA indices higher than the 95th percentile of Canadian normal children were seen in 50.0% of kidney (of liver 41.2%) recipients younger than 11 years, and in 27.3% of older recipients (of liver 37.5%). Smaller sized LDL or LDL of increased oxidizability was not more frequent in patients than in control children.

Conclusion

 

Pediatric kidney recipients had significantly higher lipid and insulin concentrations than healthy control children. Combined hyperlipidemia and features of the dysmetabolic syndrome were common in children after kidney and liver transplantation. However, no small, dense LDL, or LDL prone to oxidation was seen in either group.

Keywords:

kidney, liver, transplantation, child, lipid, triglyceride, LDL particle size, LDL oxidation, insulin, glucose

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