title: The effect of simvastatin on lowering panel reactive antibody titer in sensitized dialysis patients: a randomized placebo controlled clinical trial.
abstract: BACKGROUND
  Patients with panel reactive antibodies (PRA) have many difficulties to find a crossmatch-negative kidney for transplantation and are at a higher risk of post-transplantation rejection.
  
  
  OBJECTIVE
  To evaluate the effect of simvastatin on PRA and post-transplant outcome of these sensitized patients.
  
  
  METHODS
  82 patients with end-stage renal disease (ESRD) with a PRA ≥25% were evaluated. In a one-year follow-up, the patients were treated with simvastatin. These patients were compared with 82 matched controls receiving placebo tablets. At the end of the second and 12(th) month, PRA was rechecked in all patients. Those patients who underwent transplantation continued to take simvastatin six months after transplantation. Serum creatinine levels were checked at monthly intervals post-operation.
  
  
  RESULTS
  The mean±SD PRA level at the end of the second month was 36.63%±31.14% and 45.34%±24.36% in cases and controls, respectively (P=0.012). Seven patients in the case group and 10 in the control group were lost to follow-up. The remaining patients continued to take simvastatin for 12 month. The mean±SD PRA level at the end of the 12(th) month was 24.02%±31.04% in cases and 43.15%±26.56% in controls (P=0.001). 25 patients underwent renal transplantation and continued to receive simvastatin 6 months after transplantation. These patients were matched with 25 controls treating with placebo. The mean±SD creatinine level 6 months after kidney transplantation was 2.05±1.14 mg/dL and 3.15±1.09 mg/dL in cases and controls consecutively (P=0.02).
  
  
  CONCLUSIONS
  Simvastatin can be safely used to lower PRA and improve post-transplantation outcomes.
authors.affiliation: Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran. ; Department of Internal Medicine, Nephrology Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: J
authors.initials: J
authors.lastname: Roozbeh
authors.affiliation: Department of Internal Medicine, Nephrology Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Sattarinezhad
authors.affiliation: Department of Health and Nutrition, School of Health, Shiraz University of Medical Sciences.
authors.forename: R
authors.initials: R
authors.lastname: Afshariani
authors.affiliation: Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran. ; Department of Internal Medicine, Nephrology Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Eshraghian
authors.affiliation: Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran. ; Department of Internal Medicine, Nephrology Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: M M
authors.initials: MM
authors.lastname: Sagheb
authors.affiliation: Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran. ; Department of Internal Medicine, Nephrology Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: G
authors.initials: G
authors.lastname: Raeesjalali
authors.affiliation: Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran. ; Department of Internal Medicine, Nephrology Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: S
authors.initials: S
authors.lastname: Behzadi
authors.affiliation: Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: S
authors.initials: S
authors.lastname: Nikeghbalian
authors.affiliation: Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: M
authors.initials: M
authors.lastname: Salehipour
authors.affiliation: Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: H
authors.initials: H
authors.lastname: Salahi
authors.affiliation: Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: A
authors.initials: A
authors.lastname: Bahador
authors.affiliation: Organ Transplant Research Center, Nemazee Hospital, Shiraz University of Medical Science, Shiraz, Iran.
authors.forename: S A
authors.initials: SA
authors.lastname: Malek-Hosseini
keywords: Dialysis; End-stage renal disease; Panel reactive antibody (PRA); Renal transplantation; Simvastatin