Transplantation Immunology.pdf - E-Lib FK UWKS

18 Callaghan and Bradley
Fig. 3. Cardiovascular disease risk factors in renal transplant recipients.
In practice, the majority of renal transplant recipients receive statins and
antiplatelet agents such as aspirin in an attempt to reduce cardiovascular morbidity
and mortality. Postttransplant diabetes mellitus (PTDM) has an incidence
of 4–18% (111), and fasting blood glucose tests should be undertaken
every 3 mo (112). Initial treatment is with dietary modification, although oral
hypoglycemics or even insulin may be necessary. Preexisting diabetes requires
intensive monitoring and blood glucose control. Control of hypertension, hyperlipidemia,
and PTDM may also require modifications to the patient’s immunosuppressive
regime.
Other risk factors may also play a part in the development of CVD in the
renal transplant recipient. Elevated plasma homocysteine has been identified
as an independent factor for CVD in the renal transplant population (113), but
as yet there is no evidence that reduction of homocysteine levels reduces the
incidence of CVDs. Routine homocysteine measurement and the use of folate
supplements are therefore currently not recommended (114). Systemic inflammation
or low-grade infection may also play a role in the development of CVD