There are little data on prevalence of dyslipidemia in pediatric kidney TX recipients in the modern IS era. LP profiles of 38 TX recipients receiving triple IS with MMF, prednisone, and tacrolimus were compared with those of 11 children on HD using mixed model multiple linear regression analysis of repeated measures after adjusting for age, sex, ethnicity, duration of ESRD, and BMI. TC and LDL levels were significantly higher in TX compared with HD, whereas there was no difference in the HDL, VLDL, and TG levels. TC and LDL in TX children had no association with age, sex, ethnicity, and duration of ESRD, stage of chronic kidney disease, DM, BMI percentile, and gain in percentage IBW. Five children treated with atrovastatin had a significant reduction in TC, LDL, VLDL, and TG at 3-6 months post-treatment compared with pretreatment levels, whereas there was no difference in HDL or tacrolimus levels after treatment. No side effects of therapy were observed. Although dyslipidemia remains a significant problem in pediatric renal TX recipients in the modern era, the prevalence may have decreased with use of newer IS drugs.