Statins Benefit Outcomes of Renal Transplant Recipients on a Sirolimus-Cyclosporine Regimen

BackgroundStatins offer a strategy to address dyslipidemia commonly experienced by immunosuppressed transplant recipients.MethodsThis single-center, retrospective study of 325 recipients (mean posttransplant follow-up of over 6 years; 75.0 ± 26.0 months) correlated four adverse outcomes—biopsy-confirmed acute rejection episodes, biopsy-confirmed chronic rejection/allograft nephropathy, graft loss, or death—with demographic and posttreatment variables. Patients were treated with a combination of sirolimus (SRL), cyclosporine (CsA), and various durations of steroids. Statins were prescribed for 259/325 (79%) recipients whose serum cholesterol exceeded 240 mg/dL and discontinued when the creatine phosphokinase increased fivefold (3.4%) or the liver function, threefold (3.0%) above normal.ResultsUpon univariate (hazard ratio [HR] 0.16; P < .001) and multivariate analysis (HR 0.38; P = .02), statins were markedly protective against acute rejection episodes. They reduced occurrence of chronic nephropathy/chronic rejection (HR 0.60; P = .03 and HR 0.52; P = .01, respectively). Incidences of graft loss were diminished (HR 0.26; P < .001 and HR 0.49; P = .01, respectively). Finally, the mortality rate was decreased (HR 0.21, P = .001 and HR 0.26, P = .01, respectively). Upon multivariate analysis, a reduced incidence of acute rejection was correlated with greater exposure to SRL (HR 0.78, P = .016) and CsA (HR 0.39; P = .006).ConclusionsThis study demonstrated compelling effects of statins against all adverse outcomes among patients treated with SRL-based, CsA-containing regimens. The profoundly dyslipidemic properties of SRL may explain these unique findings compared with previous studies on patients treated with CsA-based regimens.