title: Incidence, predictors and associated outcomes of rhabdomyolysis after kidney transplantation.
abstract: BACKGROUND
  There are several case reports of rhabdomyolysis (RM) in renal transplant recipients, but the actual incidence of this complication is not known. Most of the reported cases have been attributed to drug-drug interactions with calcineurin inhibitors, with the majority of interactions reported between cyclosporine and 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins). Pharmacokinetic studies have demonstrated that cyclosporine increases statin drug levels, presumably via competitive inhibition of cytochrome P450 3A4.
  
  
  METHODS
  In a retrospective cohort of 20 366 adult Medicare primary renal transplant recipients in the USRDS database transplanted from 1 January 2003 to 31 July 2005 and followed through 31 December 2005, we assessed Medicare claims for RM and dyslipidaemia (HPL), which was used as a surrogate for statin use.
  
  
  RESULTS
  The incidence rate of RM post-transplant for the study period was 1.4 (95% CI 1.1-1.8) per 1000 person-years. By Cox regression analysis, cyclosporine (versus tacrolimus) use [AHR 2.36 (95% CI 1.23-4.35); P = 0.006] and black race [AHR 2.33 (95% CI 1.30-4.17); P = 0.005] were associated with RM. By Cox non-proportional hazards regression, RM was associated with graft loss (including death) [AHR 2.84 (95% CI 1.70-4.72); P < 0.001].
  
  
  CONCLUSIONS
  RM is a rare complication after renal transplantation and is significantly associated with allograft loss (including death). RM is significantly more likely to occur with cyclosporine (versus tacrolimus)-based immunosuppression and possibly in persons of black race. Increased surveillance for RM is warranted in these at-risk patients.
authors.affiliation: Nephrology Service, Walter Reed Army Medical Center, Washington, DC, USA. frank.hurst@us.army.mil
authors.forename: Frank P
authors.initials: FP
authors.lastname: Hurst
authors.forename: Robert T
authors.initials: RT
authors.lastname: Neff
authors.forename: Rahul M
authors.initials: RM
authors.lastname: Jindal
authors.forename: Jefferson R
authors.initials: JR
authors.lastname: Roberts
authors.forename: Krista L
authors.initials: KL
authors.lastname: Lentine
authors.forename: Lawrence Y
authors.initials: LY
authors.lastname: Agodoa
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Abbott
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D016030:Kidney Transplantation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012206:Rhabdomyolysis / Q000453:epidemiology* / Q000209:etiology*; D012307:Risk Factors; D016896:Treatment Outcome