Are statins beneficial in patients receiving kidney transplant?
Statins are the treatment of choice, and studies show there is a benefit to using them in the kidney transplant population. The incidence of dyslipidemia is high in kidney transplant patients secondary to immunosuppressive medications, proteinuria, transplant dysfunction, and the higher incidence of metabolic syndrome and new-onset diabetes after transplant. Various trials have shown improved cardiovascular outcomes with the use of lipid therapy in patient with chronic kidney disease. The Assessment of Lescol in Renal Transplantation (ALERT) study aimed to see if statin therapy reduced the primary outcome of a major cardiovascular event, including cardiac death or a cardiac intervention. The trial did not reach this primary end point due to insufficient power but did show a reduction in nonfatal myocardial infarctions. In the extended follow-up of ALERT participants, the incidence of major adverse cardiac events was reduced in patients treated with statin; however, there was no difference in patient mortality or allograft function. A Cochrane Database review stated that statins may reduce cardiovascular events in kidney transplant patients. However, statin treatment had no clear benefit in affecting overall mortality, stroke rate, kidney function, and toxicity outcomes in kidney transplant patients.
Statin use is associated with decreased proteinuria, decreased C-reactive protein, and decreased interstitial fibrosis incidence in transplant protocol biopsies, all which may confer additional benefit.