Are there any risks of statin use in kidney transplant recipients?
Yes. Most statins are metabolized by the same cytochrome P450 system (CP3A4) as calcineurin inhibitors (CNIs). As a consequence, CNIs (particularly cyclosporine) may accumulate in plasma and may be associated with a greater frequency of rhabdomyolysis. Data on tacrolimus are sparse, although pharmacokinetic studies on concomitant atorvastatin and tacrolimus therapy did not demonstrate significant interactions. Fluvastatin and pravastatin may be safer because they are metabolized through non-CP3A4 mechanisms. Fluvastatin, pravastatin, rosuvastatin, simvastatin, and atorvastatin have all been used in kidney transplant patients. These patients should be closely monitored for side effects from statin therapy. It is important to note that cyclosporine inhibits the metabolism of statins, and so the statin dose is usually kept low and not aggressively titrated up.