Safety of Concomitant Use of Tacrolimus and High-Intensity Statins in Liver and Kidney Transplant Recipients

Due to increased risk of myalgia and rhabdomyolysis associated with the use of simvastatin with cyclosporine, use of high-intensity 3-hydroxy-3-methylglutaryl Coenzyme A reductase inhibitors (statins) is often avoided in transplant recipients. Aim: This program evaluation aimed to determine the safety of high-intensity statins in liver and kidney transplant recipients taking tacrolimus. Design: All liver and kidney transplant recipients who filled prescriptions for tacrolimus and any statin except for simvastatin between June 15, 2020 and July 22, 2022 were screened for inclusion. High-intensity was defined as atorvastatin 40 or 80 mg, or rosuvastatin 20 or 40 mg. The primary outcome was a composite of statin-related myalgia, statin-related rhabdomyolysis, and creatine kinase above the upper limit of normal. Secondary outcomes included liver function tests above 3 times the upper limit of normal, statin discontinuation, and statin dose decrease and associated reason. Results: A total of 178 recipients were included, with 100 receiving low-to-moderate-intensity statins and 78 receiving high-intensity statins. There were no differences between groups for statin-related myalgia, and no reported cases of statin-related rhabdomyolysis in either group. Low to moderate intensity statin use was associated with an increased rate of liver function test elevation (26% vs 11.5%, P = .014) occurring a median of 306 days (interquartile range [IQR] 134-725) post-statin initiation. Conclusion: In liver and kidney transplant recipients receiving tacrolimus, the use of high-intensity statins was not associated with an increased risk of myalgia, rhabdomyolysis, or elevated creatinine kinase when compared with low-to-moderate-intensity statin use.