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. 2016 Feb;27(2):595-603.
doi: 10.1681/ASN.2014090857. Epub 2015 Aug 28.

HDL Cholesterol Efflux Predicts Graft Failure in Renal Transplant Recipients

Wijtske Annema  1 , Arne Dikkers  2 , Jan Freark de Boer  2 , Robin P F Dullaart  3 , Jan-Stephan F Sanders  4 , Stephan J L Bakker  4 , Uwe J F Tietge  5
Affiliations

HDL Cholesterol Efflux Predicts Graft Failure in Renal Transplant Recipients

Wijtske Annema et al. J Am Soc Nephrol. 2016 Feb.

Abstract

High-density lipoprotein (HDL) particles are involved in the protection against cardiovascular disease by promoting cholesterol efflux, in which accumulated cholesterol is removed from macrophage foam cells. We investigated whether HDL cholesterol efflux capacity is associated with cardiovascular mortality, all-cause mortality, and graft failure in a cohort of renal transplant recipients (n=495, median follow-up 7.0 years). Cholesterol efflux capacity at baseline was quantified using incubation of human macrophage foam cells with apolipoprotein B-depleted plasma. Baseline efflux capacity was not different in deceased patients and survivors (P=0.60 or P=0.50 for cardiovascular or all-cause mortality, respectively), whereas recipients developing graft failure had lower efflux capacity than those with functioning grafts (P<0.001). Kaplan-Meier analysis demonstrated a lower risk for graft failure (P=0.004) but not cardiovascular (P=0.30) or all-cause mortality (P=0.31) with increasing gender-stratified tertiles of efflux capacity. Cox regression analyses adjusted for age and gender showed that efflux capacity was not associated with cardiovascular mortality (hazard ratio [HR], 0.89; 95% confidence interval [95% CI], 0.67 to 1.19; P=0.43). Furthermore, the association between efflux capacity and all-cause mortality (HR, .79; 95% CI, 0.63 to 0.98; P=0.031) disappeared after further adjustment for potential confounders. However, efflux capacity at baseline significantly predicted graft failure (HR, 0.43; 95% CI, 0.29 to 0.64; P<0.001) independent of apolipoprotein A-I, HDL cholesterol, or creatinine clearance. In conclusion, this prospective study shows that cholesterol efflux capacity from macrophage foam cells is not associated with cardiovascular or all-cause mortality but is a strong predictor of graft failure independent of plasma HDL cholesterol levels in renal transplant recipients.

Keywords: arteriosclerosis; chronic allograft failure; lipids; mortality; transplant outcomes.

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Figures

Figure 1.
Figure 1.
Better cholesterol efflux capacity is associated with a decreased incidence of graft failure in RTRs. Kaplan–Meier curves of (A) cardiovascular mortality, (B) all-cause mortality, and (C) graft failure according to gender-stratified tertiles of cholesterol efflux. The corresponding P value was obtained from the log-rank test.
Figure 2.
Figure 2.
Cholesterol efflux capacity predicts graft failure in RTRs. ROC curves of cholesterol efflux capacity for (A) cardiovascular mortality, (B) all-cause mortality, and (C) graft failure. The dashed line represents the reference line.
See this image and copyright information in PMC

Comment in

  • HDL: Beyond Atheroprotection.
    Kon V, Linton MF. Kon V, et al. J Am Soc Nephrol. 2016 Feb;27(2):341-4. doi: 10.1681/ASN.2015070793. Epub 2015 Aug 28. J Am Soc Nephrol. 2016. PMID: 26319243 Free PMC article. No abstract available.

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