Association of Statins With Cardiovascular Outcomes Following Kidney Transplantation

Kidney transplant recipients (KTRs) face high cardiovascular risk, but the benefit of statin therapy for preventing major adverse cardiovascular events (MACE) in this population remains unclear.

We conducted a retrospective, single-center cohort study of adult KTRs between 2015 and 2024. Patients were categorized by statin use at the time of kidney transplantation (statin use [STN] vs no statin use [NoSTN]). We also conducted a separate analysis of patients with no known cardiovascular disease. The primary outcome was a composite of all-cause mortality and MACE. Cox proportional-hazards models were performed, adjusting for confounders identified from logistic regression.

A total of 518 patients (202 STN vs 316 NoSTN) were included (mean age 54.3 vs 53.1 years. The STN group had significantly more patients with a history of smoking (73.5% vs 62.1%), whereas in the NoSTN group, diabetes mellitus was more prevalent (40.2% vs 30.7%). Statin use was not associated with a significant difference in MACE (13.8% vs 15.5%, P = .62), all-cause mortality (10% in both), or the composite outcome. Similar findings were observed in the primary prevention subgroup.

Statin therapy at the time of kidney transplantation was not associated with a significant reduction in MACE or all-cause mortality in patients with and without known atherosclerotic cardiovascular disease. These results support a review of routine statin use in KTRs and highlight the need for further analysis.