Obesity and hyperhomocysteinemia are very frequently found after kidney transplantation (Tx). They may independently represent a risk factor for development of atherosclerosis and chronic allograft nephropathy. In a prospective metabolic studywe monitored, for a period of 24 months,a total of 118 obese transplant patients (BMI ≥ 30 kg/m2) with hyperhomocysteinemia. We compared the findings of a new regimen of treatment at year one (start of the study) and two years after renal transplantation. Based on a Subjective Global Assessment Scoring Sheet,westarted at theendof first year with an individualized hypoenergic-hypolipidemic diet (IHHD). Subsequently, after corticoid withdrawal, IHHD was regularly supplemented with orlistat at a dose of up to 3-times 120 mg/day, statins (pravastatin 10–40 mg), folic acid 5mg/day, and vit B6 50 mg/day and followed up for up to 2 yrs. All patients were on CyA and MMF regimen. During the study period, there was a significant decrease in BMI (P< 0.025) and tHcy level (P<0.001). Long-term therapy was associated with a significant decrease in serum leptin (P<0.001) and lipid metabolism parameters (P<0.01). The mean values of serum folate and vit. B6 also increased significantly (P<0.01), creatinine clearance, mean blood pressure, proteinuria, Lp(a) and apoE isoforms did not differ significantly. Based on our results, we assume that obesity and hyperhomocysteinemia after renal transplantation can be treated effectively by modified immunosuppression (corticosteroidwithdrawal), long-term diet (IHHD), folic acid and vit. B6 supplementation, drugs suppressing digestion or absorption to reduce atherosclerotic, and chronic allograft nephropathy processes.

        Klíčová slova: kidney transplantation, obesity, hyperhomocysteinemia, leptin, hyperlipidemia, atherosclerosis.