Background: Both AHA and ACC have no established guidelines for statin therapy among kidney transplant (KT) patients. Guidelines from the Kidney Disease Improving Global Outcomes (KDIGO) recommend the use of statins among adult KT patients; however, the optimum statin intensity is unknown. The aim of our study was to determine the impact of pre-KT statin intensity on survival among KT patients.
Methods: Patients who had undergone kidney transplantation in our institution from 2005-2015 were included in this retrospective data analysis. Data on highest statin intensity use prior to kidney transplant, lipid profile and survival data were obtained. Patients were divided into 3 groups depending on the intensity of statin used: 1) Low, 2) Moderate and 3) High. Statin intensity classification was based on 2013 ACC/AHA Guidelines. Chi square and Kaplan Meier (KM) tests were done to compare mortality rates and survival among the three groups. Kruskal Wallis test was used to analyze TG, HDL and LDL distribution between groups.
Results: Of the 986 patients who underwent kidney transplantation in our institution, 265 had reported pre-KT statin use. The median follow-up time of the entire cohort was 3.5 years (IQR 1.5-5.5 years). All-cause mortality rate among all statin users was 15.8% (N=42). Mortality rate in the Low (n=81), Moderate (n=136) and High (n=48) groups were: 27.2 %, 14.7% and 0%, respectively (p<0.001). KM showed improved survival with high intensity statin (log rank p=0.001, Figure 1). Pairwise comparison of individual groups showed improving survival with increasing statin intensities. Lipid profiles indicated that only LDL distribution was different between the three groups: 86±16 mg/dL, 105±12 mg/dL, and 80±41 mg/dL respectively (p=0.035).
Conclusion: Among kidney transplant patients on a statin, higher intensity statins are associated lower LDL and improved survival. Whether this finding is a statin effect or LDL effect will warrant prospective studies.