Statin therapy associated with a reduced risk of chronic renal failure after cardiac transplantation.
BACKGROUND
Chronic renal failure (CRF) after heart transplantation is common, although risk factors for its development and potential preventive interventions are not well established.


METHODS
In this study we retrospectively assessed the cumulative incidence of CRF and identified independent predictors of CRF in heart transplant recipients between August 1986 and January 2003.


RESULTS
Among the 218 patients included in the analysis, the cumulative incidence of CRF was 4.5% at 5 years, and 19.6% at 10 years after transplant. Multivariate Cox modeling revealed that diabetes mellitus prior to transplant was associated with an increased risk of CRF (hazards ratio [HR] 7.11, p < 0.01), whereas factors associated with a reduced risk of CRF included a pre-transplant creatinine clearance > or = 60 ml/min/1.73 m2 (HR 0.30, p = 0.01) and treatment with a statin after transplant (HR 0.25, p < 0.01). Patients who developed CRF after transplant were at higher risk of death (HR 8.5, p < 0.01).


CONCLUSIONS
CRF is common after cardiac transplantation and is associated with substantial mortality. The reduced risk of CRF observed with statin therapy warrants prospective study, with particular emphasis on the mechanisms of progression to CRF in this population.
Lubitz
Steven A
SA
Zena and Michael Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, New York, USA.
Pinney
Sean
S
Wisnivesky
Juan P
JP
Gass
Alan
A
Baran
David A
DA
D000328:Adult; D001794:Blood Pressure; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D008074:Lipoproteins / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011184:Postoperative Period; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D013997:Time Factors
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D008074:Lipoproteins