Should all patients who have received kidney transplants receive statin therapy

Should all patients who have received kidney transplants receive statin therapy?

The KDIGO guidelines suggest that all kidney transplant recipients should receive therapy with a statin.

The ALERT (Assessment of Lescol in Renal Transplant) trial was a large study that randomly assigned 2102 kidney transplant recipients aged 30 to 75 years to either fluvastatin, 40 mg (later 80 mg), or placebo. Over 5.7 years of follow-up, fluvastatin reduced the risk of cardiac deaths and nonfatal myocardial infarction but did not reduce the rates of coronary intervention cerebrovascular events, noncardiovascular death, all-cause mortality, and graft loss.

In a subsequent 2-year open-label extension in which all participants of the trial were offered fluvastatin treatment, 1652 participants agreed to receive 80 mg of fluvastatin while 442 participants declined.

An intention-to-treat analysis by original treatment group demonstrated that participants randomized to the drug had a borderline statistically significant lower risk of incident CVD events and mortality.

A meta-analysis of 22 RCT studies further reported that statin treatment had uncertain effects on overall mortality, but that CVD outcomes may be reduced.

Given the lack of robust data, KDIGO suggested, rather than recommended, the use of statins in these patients.

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