HYPERHOMOCYST(E)INEMIA AS AN INDEPENDENT RISK FACTOR FOR CARDIOVASCULAR DISEASE IN RENAL TRANSPLANT RECIPIENTS.

Limited data are available on the prevalence, determinants and clinical significance of hyperhomocyst(e)inemia in renal transplant recipients. We conducted a cross-sectional study on homocysteine determinants and clinical correlates in renal transplant recipients. Plasma homocyst(e)ine (Hcy) concentrations and factors known to influence homocysteine metabolism were analyzed in 224 renal transplant recipients. Atherosclerotic complications were evaluated with respect to plasma homocysteine concentrations and other known risk factors for CVD. Mean Hcy was 21.3 +/- 9.7 umol/l. After adjusting for confounding factors, patients with and without Cyclosporin A (CsA) had similar Hcy concentrations. We found a significant inverse relationship between Hcy and folic acid concentrations in both CsA (+)

(r = -0.243; p < 0.005) and CsA (-) (r = 0.396; p < 0.05) patients. Patients with a past history of cardiovascular events had higher Hcy concentrations than those without cardiovascular antecedent (25.2 +/- 11.7 mmol/l vs 20.5 +/- 6.9 mmol/l; p < 0.005). Multivariate-adjusted analyses revealed that Hcy was independently associated with cardiovascular disease. In multivariate analysis, only age, hyperlipidemia, smoking and obesity remained associated with CVD. Hyperhomocyst(e)inemia is an independent risk factor for cardiovascular disease in renal transplant recipients. Prospective placebo-controlled homocysteine lowering therapy studies are required in this patients category.

Didier DUCLOUX, Christophe RUEDIN, Roger GIBEY, Jean-Michel REBIBOU, Catherine BRESSON-VAUTRIN, Jean-Marc CHALOPIN. Department of Nephrology and Renal Transplantation; Hospital Saint Jacques; Besancon, FRANCE