В статье анализируется информация о причинах и механизмах развития и распространенности дислипидемии у больных с трансплантированной печенью. Авторы интегрируют данные из отечественной и зарубежной литературы о приоритетах выбора гиполипидемических препаратов и возможностях изменения схем иммуносупрессивной фармакотерапии, позволяющей снизить риски возникновения и прогрессирования сердечно-сосудистой патологии у пациентов, подвергнувшихся ортотопической трансплантации печени.
The article analyzes information of the prevalence, causes and mechanisms of development of dyslipidemia in patients after liver transplantation. The authors integrate data from domestic and foreign literature about priorities of choice of lipid-lowering drugs and possible changes in patterns of immunosuppressive drug therapy to reduce the risk of onset and progression of cardiovascular disease in patients who were underwent orthotopic liver transplantation.
1. Национальные рекомендации по кардиоваскулярной профилактике. 1-е изд. 2011. Кардиоваск. терапия и профилактика. 2011; 10 (6; Прил. 2). / Natsional'nye rekomendatsii po kardiovaskuliarnoi profilaktike. 1-e izd. 2011. Kardiovask. terapiia i profilaktika. 2011; 10 (6; Pril. 2). [in Russian]
2. Gisbert C, Prieto M, Berenguer M et al. Hyperlipidemia in liver transplant recipients: prevalence and risk factors. Liver Transpl Surg 1997; 3 (4): 416–22.
3. Bianchi G, Marchesini G, Marzocchi R et al. Metabolic syndrome in liver transplantation: relation to etiology and immunosuppression. Liver Transpl 2008; 14 (11): 1648–54.
4. Guckelberger O, Bechstein WO, Neuhaus R et al. Cardiovascular risk factors in long-term follow-up after orthotopic liver transplantation. Clin Transpl 1997; 11 (1): 60–5.
5. Laryea M, Watt KD, Molinari M et al. Metabolic syndrome in liver transplant recipients: prevalence and association with major vascular events. Liver Transpl 2007; 13 (8): 1109–14.
6. Muñoz LE, Nañez H, Rositas F et al. Long-term complications and survival of patients after orthotopic liver transplantation. Transplant Proc 2010; 42 (6): 2381–2.
7. Muñoz SJ, ElGenaidi H. Cardiovascular risk factors after liver transplantation. Liver Transpl 2005; 11 (Suppl. 2): S52–S56.
8. Kobashigawa JA, Kasiske BL. Hyperlipidemia in solid organ transplantation. Transplantation 1997; 63: 331–8.
9. Imagawa DK, Dawson S, 3rd, Holt CD et al. Hyperlipidemia after liver transplantation: natural history and treatment with the hydroxy-methylglutaryl-coenzyme A reductase inhibitor pravastatin. Transplantation 1996; 62: 934–42.
10. Munoz SJ, Deems RO, Moritz MJ et al. Hyperlipidemia and obesity after orthotopic liver transplantation. Transplant Proc 1991; 23: 1480–3.
11. Lucey MR, Terrault N, Ojo L et al. Long‐Term Management of the Successful Adult Liver Transplant: 2012 Practice Guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Liver Transpl 2013; 19: 3–26.
12. Bianchi G, Marchesini G, Marzocchi R et al. Metabolic syndrome in liver transplantation: relation to etiology and immunosuppression. Liver Transpl 2008; 14 (11): 1648–54.
13. Neal DA, Tom BD, Luan J. Is there disparity between risk and incidence of cardiovascular disease after liver transplant? Transplantation 2004; 77 (1): 93–9.
14. Johnston SD, Morris JK, Cramb R et al. Cardiovascular morbidity and mortality after orthotopic liver transplantation. Transplantation 2002; 73 (6): 901–6.
15. Ciccarelli O, Kaczmarek B, Roggen F. Long-term medical complications and quality of life in adult recipients surviving 10 years or more after liver transplantation. Acta Gastroenterol Belg 2005; 68 (3): 323–30.
16. Watt KD, Pedersen RA, Kremers WK et al. Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK long-term follow-up study. Am J Transpl 2010; 10 (6): 1420–7.
17. Neal DA, Gimson AE, Gibbs P, Alexander GJ. Beneficial effects of converting liver transplant recipients from cyclosporine to tacrolimus on blood pressure, serum lipids, and weight. Liver Transpl 2001; 7 (6): 533–9.
18. Clark W. Tacrolimus: immunosuppression following liver and kidney transplant. J Clin Pharm Ther 1996; 21: 135–41.
19. Guckelberger O, Bechstein WO, Neuhaus R et al. Cardiovascular risk factors in long-term follow-up after orthotopic liver transplantation. Clin Transplant 1997; 11: 60–5.
20. Rabkin JM, Corless CL, Rosen HR, Olyaei AJ. Immunosuppression impact on long-term cardiovascular complications after liver transplantation. Am J Surg 2002; 183: 595–9.
21. Stegall MD, Wachs ME, Everson G et al. Prednisone withdrawal 14 days after liver transplantation with mycophenolate: a prospective trial of cyclosporine and tacrolimus. Transplantation 1997; 64: 1755–60.
22. Manzarbeitia C, Reich DJ, Rothstein KD et al. Tacrolimus conversion improves hyperlipidemic states in stable liver transplant recipients. Liver Transpl 2001; 7: 93–9.
23. Morard I, Dumortier J, Spahr L. Conversion to sirolimus-based immunosuppression in maintenance liver transplantation patients. Liver Transpl 2007; 13 (5): 658–64.
24. Stegall MD, Everson GT, Schroter G et al. Prednisone withdrawal late after adult liver transplantation reduces diabetes, hypertension, and hypercholesterolemia without causing graft loss. Hepatology 1997; 25: 173–7.
25. Boillot O, Mayer DA, Boudjema K et al. Corticosteroid-free immunosuppression with tacrolimus following induction with daclizumab: a large randomized clinical study. Liver Transpl 2005; 11: 61–7.
26. Segev DL, Sozio SM, Shin EJ et al. Steroid avoidance in liver transplantation: meta-analysis and meta-regression of randomized trials. Liver Transpl 2008; 14: 512–25.
27. Moench C, Barreiros AP, Schuchmann M et al. Tacrolimus monotherapy without steroids after liver transplantation-a prospective randomized double-blinded placebo-controlled trial. Am J Transpl 2007; 7: 1616–23.
28. Siddharth Singh, Watt KD. Long-term medical management of the liver transplant recipient: what the primary care physician needs to know. Mayo Clin Proc 2012; 87 (8): 779–90.
29. Космачева Е.Д., Бабич А.Э. Особенности ведения пациентов с артериальной гипертензией после трансплантации печени. Системные гипертензии. 2014; 4: 55–7. / Kosmacheva E.D., Babich A.E. Peculiarity of medical management of patients with arterial hypertension after liver transplantation. System Hypertension. 2014; 4: 55–7. [in Russian]
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31. Покровский В.М., Компаниец О.Г. Регуляторно-адаптивный статус пациентов с гипертонической болезнью при медикаментозном достижении целевых уровней артериального давления. Системные гипертензии. 2011; 2: 58–60. / Pokrovskii V.M., Kompaniets O.G. Regulatory-adaptive status of hypertensive patients during achievement target level of blood pressure. System Hypertension. 2011; 2: 58–60. [in Russian]
32. Ратова Л.Г., Чазова И.Е. Эффективность и безопасность лечения b-адреноблокатором III поколения пациентов с артериальной гипертонией. Consilium Medicum. 2009; 5. / Ratova L.G., Chazova I.E. Effektivnost' i bezopasnost' lecheniia b-adrenoblokatorom III pokoleniia patsientov s arterial'noi gipertoniei. Consilium Medicum. 2009; 5. [in Russian]
33. Компаниец О.Г., Аверин Е.Е. Приоритеты выбора диуретиков при лечении гипертонической болезни: доказательная медицина, рекомендательные документы и реальная клиническая практика. Системные гипертензии. 2013; 1: 62–5. / Kompaniets O.G., Averin E.E. Priorities for choosing diuretics in the treatment of hypertensive disease: Evidence-based medicine, recommendation documents, and real clinical practice. System Hypertension. 2013; 1: 62–5. [in Russian]
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35. Пономарева А.И., Одноволов О.Т., Компаниец О.Г., Чернявская Д.Е. Комбинированная фармакотерапия артериальной гипертензии. Consilium Medicum. 2013; 1: 11–4. / Ponomareva A.I., Odnovolov O.T., Kompaniets O.G., Cherniavskaia D.E. Kombinirovannaia farmakoterapiia arterial'noi gipertenzii. Consilium Medicum. 2013; 1: 11–4. [in Russian]
36. International Atherosclerosis Society, IAS. Меморандум Международного общества по изучению атеросклероза: Общие рекомендации по лечению дислипидемии. 2014; с. 1–67. http://scardio.ru/content/Guidelines/IAS/PositionPaperRussianlanguage.pdf США / International Atherosclerosis Society, IAS. Memorandum Mezhdunarodnogo obshchestva po izucheniiu ateroskleroza: Obshchie rekomendatsii po lecheniiu dislipidemii. 2014; s. 1–67. http://scardio.ru/content/Guidelines/IAS/PositionPaperRussianlanguage.pdf SShA [in Russian]
37. Martin JE, Cavanaugh TM, Trumbull L. Incidence of adverse events with HMG-CoA reductase inhibitors in liver transplant patients. Clin Transpl 2008; 22 (1): 113–9.
38. Asberg A. Interactions between cyclosporin and lipid-lowering drugs: implications for organ transplant recipients. Drugs 2003; 63 (4): 367–78.
39. Общероссийская общественная организация трансплантологов «Российское трансплантологическое общество». Трансплантация печени. Национальные клинические рекомендации 2013. http://transpl.ru/images/cms/data/pdf/nacional_nye_klinicheskie_rekomendacii_po_transplantacii_peche... / Obshcherossiiskaia obshchestvennaia organizatsiia transplantologov «Rossiiskoe transplantologicheskoe obshchestvo». Transplantatsiia pecheni. Natsional'nye klinicheskie rekomendatsii 2013. http://transpl.ru/images/cms/data/pdf/nacional_nye_klinicheskie_rekomendacii_po_transplantacii_peche... [in Russian]
40. Государственный реестр лекарственных средств. http://grls.rosminzdrav.ru / Gosudarstvennyi reestr lekarstvennykh sredstv. http://grls.rosminzdrav.ru [in Russian]
41. McKenney JM, Sica D. Prescription omega-3 fatty acids for the treatment of hypertriglyceridemia. Am J Health Syst Pharm 2007; 64 (6): 595–605.
42. Lee S, Gura KM, Puder M. Omega-3 fatty acids and liver disease. Hepatology 2007; 45 (4): 841–5.
43. Almutairi F, Peterson TC, Molinari M. Safety and effectiveness of ezetimibe in liver transplant recipients with hypercholesterolemia. Liver Transpl 2009; 15 (5): 504–8.
________________________________________________
1. Natsional'nye rekomendatsii po kardiovaskuliarnoi profilaktike. 1-e izd. 2011. Kardiovask. terapiia i profilaktika. 2011; 10 (6; Pril. 2). [in Russian]
2. Gisbert C, Prieto M, Berenguer M et al. Hyperlipidemia in liver transplant recipients: prevalence and risk factors. Liver Transpl Surg 1997; 3 (4): 416–22.
3. Bianchi G, Marchesini G, Marzocchi R et al. Metabolic syndrome in liver transplantation: relation to etiology and immunosuppression. Liver Transpl 2008; 14 (11): 1648–54.
4. Guckelberger O, Bechstein WO, Neuhaus R et al. Cardiovascular risk factors in long-term follow-up after orthotopic liver transplantation. Clin Transpl 1997; 11 (1): 60–5.
5. Laryea M, Watt KD, Molinari M et al. Metabolic syndrome in liver transplant recipients: prevalence and association with major vascular events. Liver Transpl 2007; 13 (8): 1109–14.
6. Muñoz LE, Nañez H, Rositas F et al. Long-term complications and survival of patients after orthotopic liver transplantation. Transplant Proc 2010; 42 (6): 2381–2.
7. Muñoz SJ, ElGenaidi H. Cardiovascular risk factors after liver transplantation. Liver Transpl 2005; 11 (Suppl. 2): S52–S56.
8. Kobashigawa JA, Kasiske BL. Hyperlipidemia in solid organ transplantation. Transplantation 1997; 63: 331–8.
9. Imagawa DK, Dawson S, 3rd, Holt CD et al. Hyperlipidemia after liver transplantation: natural history and treatment with the hydroxy-methylglutaryl-coenzyme A reductase inhibitor pravastatin. Transplantation 1996; 62: 934–42.
10. Munoz SJ, Deems RO, Moritz MJ et al. Hyperlipidemia and obesity after orthotopic liver transplantation. Transplant Proc 1991; 23: 1480–3.
11. Lucey MR, Terrault N, Ojo L et al. Long‐Term Management of the Successful Adult Liver Transplant: 2012 Practice Guideline by the American Association for the Study of Liver Diseases and the American Society of Transplantation. Liver Transpl 2013; 19: 3–26.
12. Bianchi G, Marchesini G, Marzocchi R et al. Metabolic syndrome in liver transplantation: relation to etiology and immunosuppression. Liver Transpl 2008; 14 (11): 1648–54.
13. Neal DA, Tom BD, Luan J. Is there disparity between risk and incidence of cardiovascular disease after liver transplant? Transplantation 2004; 77 (1): 93–9.
14. Johnston SD, Morris JK, Cramb R et al. Cardiovascular morbidity and mortality after orthotopic liver transplantation. Transplantation 2002; 73 (6): 901–6.
15. Ciccarelli O, Kaczmarek B, Roggen F. Long-term medical complications and quality of life in adult recipients surviving 10 years or more after liver transplantation. Acta Gastroenterol Belg 2005; 68 (3): 323–30.
16. Watt KD, Pedersen RA, Kremers WK et al. Evolution of causes and risk factors for mortality post-liver transplant: results of the NIDDK long-term follow-up study. Am J Transpl 2010; 10 (6): 1420–7.
17. Neal DA, Gimson AE, Gibbs P, Alexander GJ. Beneficial effects of converting liver transplant recipients from cyclosporine to tacrolimus on blood pressure, serum lipids, and weight. Liver Transpl 2001; 7 (6): 533–9.
18. Clark W. Tacrolimus: immunosuppression following liver and kidney transplant. J Clin Pharm Ther 1996; 21: 135–41.
19. Guckelberger O, Bechstein WO, Neuhaus R et al. Cardiovascular risk factors in long-term follow-up after orthotopic liver transplantation. Clin Transplant 1997; 11: 60–5.
20. Rabkin JM, Corless CL, Rosen HR, Olyaei AJ. Immunosuppression impact on long-term cardiovascular complications after liver transplantation. Am J Surg 2002; 183: 595–9.
21. Stegall MD, Wachs ME, Everson G et al. Prednisone withdrawal 14 days after liver transplantation with mycophenolate: a prospective trial of cyclosporine and tacrolimus. Transplantation 1997; 64: 1755–60.
22. Manzarbeitia C, Reich DJ, Rothstein KD et al. Tacrolimus conversion improves hyperlipidemic states in stable liver transplant recipients. Liver Transpl 2001; 7: 93–9.
23. Morard I, Dumortier J, Spahr L. Conversion to sirolimus-based immunosuppression in maintenance liver transplantation patients. Liver Transpl 2007; 13 (5): 658–64.
24. Stegall MD, Everson GT, Schroter G et al. Prednisone withdrawal late after adult liver transplantation reduces diabetes, hypertension, and hypercholesterolemia without causing graft loss. Hepatology 1997; 25: 173–7.
25. Boillot O, Mayer DA, Boudjema K et al. Corticosteroid-free immunosuppression with tacrolimus following induction with daclizumab: a large randomized clinical study. Liver Transpl 2005; 11: 61–7.
26. Segev DL, Sozio SM, Shin EJ et al. Steroid avoidance in liver transplantation: meta-analysis and meta-regression of randomized trials. Liver Transpl 2008; 14: 512–25.
27. Moench C, Barreiros AP, Schuchmann M et al. Tacrolimus monotherapy without steroids after liver transplantation-a prospective randomized double-blinded placebo-controlled trial. Am J Transpl 2007; 7: 1616–23.
28. Siddharth Singh, Watt KD. Long-term medical management of the liver transplant recipient: what the primary care physician needs to know. Mayo Clin Proc 2012; 87 (8): 779–90.
29. Kosmacheva E.D., Babich A.E. Peculiarity of medical management of patients with arterial hypertension after liver transplantation. System Hypertension. 2014; 4: 55–7. [in Russian]
30. Pokrovskii VM, Kompaniets OG. Influence of the level of blood pressure on the regulatory-adaptive state. Hum Physiol 2012; 38 (5): 539–42.
31. Pokrovskii V.M., Kompaniets O.G. Regulatory-adaptive status of hypertensive patients during achievement target level of blood pressure. System Hypertension. 2011; 2: 58–60. [in Russian]
32. Ratova L.G., Chazova I.E. Effektivnost' i bezopasnost' lecheniia b-adrenoblokatorom III pokoleniia patsientov s arterial'noi gipertoniei. Consilium Medicum. 2009; 5. [in Russian]
33. Kompaniets O.G., Averin E.E. Priorities for choosing diuretics in the treatment of hypertensive disease: Evidence-based medicine, recommendation documents, and real clinical practice. System Hypertension. 2013; 1: 62–5. [in Russian]
34. Kartasheva E.D., Linchak R.M. Rol' b-adrenoblokatorov v lechenii i profilaktike serdechno-sosudistykh zabolevanii: aktsent na karvedilol. Trudnyi patsient. 2010; 8 (5): 21–7. [in Russian]
35. Ponomareva A.I., Odnovolov O.T., Kompaniets O.G., Cherniavskaia D.E. Kombinirovannaia farmakoterapiia arterial'noi gipertenzii. Consilium Medicum. 2013; 1: 11–4. [in Russian]
36. International Atherosclerosis Society, IAS. Memorandum Mezhdunarodnogo obshchestva po izucheniiu ateroskleroza: Obshchie rekomendatsii po lecheniiu dislipidemii. 2014; s. 1–67. http://scardio.ru/content/Guidelines/IAS/PositionPaperRussianlanguage.pdf SShA [in Russian]
37. Martin JE, Cavanaugh TM, Trumbull L. Incidence of adverse events with HMG-CoA reductase inhibitors in liver transplant patients. Clin Transpl 2008; 22 (1): 113–9.
38. Asberg A. Interactions between cyclosporin and lipid-lowering drugs: implications for organ transplant recipients. Drugs 2003; 63 (4): 367–78.
39. Obshcherossiiskaia obshchestvennaia organizatsiia transplantologov «Rossiiskoe transplantologicheskoe obshchestvo». Transplantatsiia pecheni. Natsional'nye klinicheskie rekomendatsii 2013. http://transpl.ru/images/cms/data/pdf/nacional_nye_klinicheskie_rekomendacii_po_transplantacii_peche... [in Russian]
40. Gosudarstvennyi reestr lekarstvennykh sredstv. http://grls.rosminzdrav.ru [in Russian]
41. McKenney JM, Sica D. Prescription omega-3 fatty acids for the treatment of hypertriglyceridemia. Am J Health Syst Pharm 2007; 64 (6): 595–605.
42. Lee S, Gura KM, Puder M. Omega-3 fatty acids and liver disease. Hepatology 2007; 45 (4): 841–5.
43. Almutairi F, Peterson TC, Molinari M. Safety and effectiveness of ezetimibe in liver transplant recipients with hypercholesterolemia. Liver Transpl 2009; 15 (5): 504–8.
Авторы
Е.Д.Космачева1,2, А.Э.Бабич*2
1 ГБОУ ВПО Кубанский государственный медицинский университет Минздрава России. 350063, Россия, Краснодар, ул. Седина, д. 4
2 ГБУЗ НИИ-Краевая клиническая больница №1 им. проф. С.В.Очаповского Минздрава Краснодарского края. 350029, Россия, Краснодар, ул. 1 Мая, д. 16.
*Anna-babich1@yandex.ru
________________________________________________
E.D.Kosmacheva1,2, A.E.Babich*2
1 Kuban State Medical University, Ministry of Health of the Russian Federation. 350063, Russian Federation, Krasnodar, ul. Sedina, d. 4;
2 The Research Institute-Regional Clinical Hospital №1 named after Prof. S.V.Ochapovsky of the Ministry of Health of the Krasnodar Region. 350029, Russian Federation, Krasnodar, ul. 1 Maia, d. 16
*Anna-babich1@yandex.ru