Purpose: Dyslipidemia is a common comorbidity in patients on the transplant waitlist and post-transplant, and hyperlipidemia has been associated with more robust immune response, possibly increasing risk for rejection.

Methods: We performed a retrospective cohort study of adult kidney transplant recipients at one large center (1999-2014) who had a lipid panel assessed prior to transplantation and were initially on tacrolimus post-transplant. We evaluated predictors for rejection utilizing a backwards-stepwise Cox regression model (adjusted hazard ratio calculated; aHR) including lipid levels, statin exposure at 1 month post-transplant, as well as covariates commonly associated with rejection. Rejection was defined as biopsy-proven antibody-mediated or cellular rejection occurring at any time post-transplant, and only first occurrences were included.

Results: There were 1852 patients with evaluable data during this timeframe, 160 experiencing rejection, of which 121 were cellular rejections and 50 were antibody-mediated rejections. The median time to any rejection was 7.6 months post-transplant. Induction immunosuppression was mainly anti-thymocyte globulin with 87.7% of patients receiving and 90.5% were initially maintained on mycophenolate, all patients were maintained on steroids. In patients experiencing rejection, mean HDL was 46 as compared to 49 for those rejection free (p = 0.032). Each 10 mg/dl increase in HDL was associated with a 10.5% reduction in the adjusted hazard of acute rejection. Additional factors associated with acute rejection included black race, patient age at transplant, and year of transplant. Acute cellular rejection rates correlated with HDL (10.2% risk reduction for every 10 mg/dL increase), race, age, and year. Treatment with statins starting in the first month post-transplant did not affect rates of rejection.

Conclusion: Lower pre-transplant HDL levels are associated with increased risk of acute rejection after kidney transplantation. Further research is necessary to determine best strategies to evaluate and mitigate associated risks.

CITATION INFORMATION: Hagopian J, Brennan D, Lentine K, Horwedel T. Higher Pre-Transplant HDL Levels Are Associated with Decreased Acute Rejection Following Kidney Transplant. Am J Transplant. 2016;16 (suppl 3).

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