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EZETIMIBE IN LIVER TRANSPLANTATION: INITIAL EXPERIENCE
F Almutairi, TC Peterson1, KM Peltekian
Atlantic Multi-Organ Transplantation Program and the Departments of Medicine, and 1Pharmacology, Dalhousie University, Halifax, Nova Scotia
Hypercholesterolemia is a common problem among liver transplant recipients and is often exacerbated by immunosuppressive drugs. In spite package insert warnings, statins are used in patients with chronic liver disease and post-liver transplantation often with good results, but control is suboptimal due to adverse effects. Ezetimibe acts through inhibition of enterohepatic recirculation, a complementary mechanism to statins. Our objective was to assess retrospectively, the efficacy and safety of ezetimibe among our liver transplant population since this has been reviewed previously only in kidney and heart transplant patients.
PATIENTS AND METHODS: We included 25 stable patients with LDL-cholesterol > 2.5 umol/L. Determinations were performed at baseline, 3- and 6-months. We analyzed the lipid profile, liver profile and immunosuppressant dose and blood levels. The statistics were Student’s t test for paired samples. The study was approved by the Capital District Research Ethics Board.
RESULTS: The overall mean age (± SD) was 58 ± 12 years with 56% males. Patients were already on statins (32%) and fibrates (20%) for high LDL and/or triglyceridemia, respectively. Immunosuppressant was cyclosporine (48%), tacrolimus (32%), sirolimus (48%), mycophenolate (44%) and prednisone (80%) with maximum 5 mg OD dose. The ezetimibe dose was 10 mg/day in 92% of cases. After starting ezetimibe, we observed 11% reduction in total cholesterol values (total cholesterol at baseline: 6.1 ± 1.2, and after 6 months: 5.4 ± 1.2 umol/L; P = 0.022) and 18% reduction in LDL-cholesterol values (LDL-cholesterol at baseline: 3.8 ± 0.9, and at 6 months: 3.1 ± 0.8 umol/L; P = 0.010). The remaining variables did not show significant differences. We did not see any changes in medication dose or immunosuppressant levels. One subject discontinued the drug 3 months later due to cost, two subjects had minimal nausea, one subject had myalgias without rise in CPK and one subject had transient 3-5 times elevation in liver enzymes from baseline with minimal rise in bilirubin.
CONCLUSION: Treatment with ezetimibe among liver transplant patients was well tolerated and effective in improving the cholesterol profile.