Table 2.

Management of Metabolic Risk Factors (Based on References 40, 41, 42).

Parameter	Management	IS modification
Low-density lipoprotein >100 mg/dL	Life style modification, diet changes Statins ± addition of Ezetimibe if not controlled by diet and lifestyle	Cyclosporine conversion to Tacrolimus Calcineurin inhibitors reduction and addition of Mycophenolate mTORi discontinuation (weak recommendations)
Higher triglycerides	Fibric acid derivatives, fish oils
Diabetes mellitus	Target HbA1c < 7% by lifestyle changes and medications, insulin is preferred when patient is on high doses of steroids	Steroid short-term only/avoidance Tacrolimus to Cyclosporine (if poor glycemic control, (grade 2, level B evidence)
Hypertension	Treatment target: blood pressure 130/80 mm Hg Amlodipine/Nifedipine may be preferred as these agents counteract real vasoconstrictor effect of calcineurin inhibitors Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers preferred in presence of chronic kidney disease, diabetes/proteinuria, heart failure with monitoring for hyperkalemia Beta blockers: in patients with coronary artery disease or heart failure	Minimization of steroids and calcineurin inhibitors