title: HMG-CoA reductase inhibitors in kidney transplant recipients receiving tacrolimus: statins not associated with improved patient or graft survival.
abstract: BACKGROUND
  The beneficial effects of early statin use in kidney transplant recipients, especially those on tacrolimus-based immunosuppression, are not well established. We evaluated the predictors of statin use following kidney transplantation and examined its association with patient and allograft survival.
  
  
  METHODS
  We examined 615 consecutive patients who underwent kidney transplant at our institution between January 1998 and January 2002. Statin use was assessed at baseline and 3, 6, 9, and 12 months following kidney transplant. Patients were followed for allograft and patient survival.
  
  
  RESULTS
  36% of the 615 kidney transplant recipients were treated with statin treatment. Statin use increased over the course of the study period. Older age, elevated body mass index, higher triglyceride levels, hypercholesterolemia, diabetes, history of myocardial infarction were associated with higher rates of statin use; elevated alkaline phosphatase levels and CMV IgG seropositivity were associated with less statin use. Older age, elevated BMI and hypercholesterolemia remained significant predictors of increased statin use after accounting for covariates using multiple regression. The early use of statins was not associated with improvements in unadjusted patient survival [HR 0.99; 95%CI 0.72-1.37] or graft survival [HR 0.97; 95% CI 0.76-1.24]. The risks of death and graft survival were not consistently reduced with exposure to statin using either adjusted models or propensity scores in Cox Proportional Hazards models.
  
  
  CONCLUSIONS
  In a kidney transplant population primarily receiving tacrolimus-based immunosuppression, early statin use was not associated with significantly improved graft or patient survival.
authors.affiliation: Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, PA, USA.
authors.forename: Nizar
authors.initials: N
authors.lastname: Younas
authors.forename: Christine M
authors.initials: CM
authors.lastname: Wu
authors.forename: Ron
authors.initials: R
authors.lastname: Shapiro
authors.forename: Jerry
authors.initials: J
authors.lastname: McCauley
authors.forename: James
authors.initials: J
authors.lastname: Johnston
authors.forename: Henkie
authors.initials: H
authors.lastname: Tan
authors.forename: Amit
authors.initials: A
authors.lastname: Basu
authors.forename: Heidi
authors.initials: H
authors.lastname: Schaefer
authors.forename: Cynthia
authors.initials: C
authors.lastname: Smetanka
authors.forename: Wolfgang C
authors.initials: WC
authors.lastname: Winkelmayer
authors.forename: Mark
authors.initials: M
authors.lastname: Unruh
mesh_terms: D000328:Adult; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000188:drug therapy / Q000401:mortality; D006085:Graft Survival / Q000187:drug effects*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D016030:Kidney Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009934:Organization and Administration; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D016559:Tacrolimus / Q000627:therapeutic use*; D014184:Transplantation, Homologous
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007166:Immunosuppressive Agents; D016559:Tacrolimus