Safety and efficacy of pravastatin therapy for the prevention of hyperlipidemia in pediatric and adolescent cardiac transplant recipients

Pravastatin therapy is associated with reduction in coronary allograft vasculopathy in pediatric heart transplantation

“…Several other investigators have reported that cholesterol and triglyceride levels are significantly elevated in school-age and adolescent heart transplant recipients. 11,12 In the present study we found perturbations in lipid profiles, although generally mild, to be common.…”

“…There were also no differences in alanine transaminase pre-versus post-atorvastatin therapy. Penson and colleagues 11 found that pravastatin significantly decreased total cholesterol and LDL cholesterol. Interestingly, these authors found that pravastatin had a more significant effect in patients managed with cyclosporine compared to tacrolimus due at least in part to the greater degree of lipid abnormalities associated with cyclosporine.…”

Variability in hepatic expression of organic anion transporter 7/SLC22A9, a novel pravastatin uptake transporter: impact of genetic and regulatory factors

“…Furthermore, pharmacokinetic studies have shown that the concomitant use of cyclosporine A and pravastatin leads to a 10-fold increase in pravastatin levels, which is considered to be due to the inhibition of OATP1B1 via cyclosporine A as the major pravastatin uptake transporter. 18,19 However, pravastatin is still effective in reducing serum cholesterol levels in transplant patients receiving cyclosporine A 19,38 suggesting an alternate pravastatin uptake mechanism in hepatocytes. Because all hepatically expressed OATPs (that is, OATP1B1, OATP1B3, OATP2B1) are inhibited by cyclosporine A as suggested by in vitro studies 17 while OAT7 is apparently not inhibited (Figure 2d), we hypothesize that OAT7 may contribute to pravastatin uptake into hepatocytes under these conditions.…”

Hyperlipidemia in Children After Heart Transplantation

“…34 Although small single-center studies have demonstrated the safety and efficacy of atorvastatin and pravastatin in pediatric heart transplant recipients, an empirical strategy has not been widely adopted for children because the longterm effects of this therapy for children are not known. 35,36 The results of our study provide an assessment of the proportion of all post-transplant patients who would need to be treated for lipid levels above certain pre-defined values. Large prospective studies in posttransplant pediatric patients using coronary IVUS would be helpful in assessing the relationship between lipid levels and early GCV and in defining the effect of specific therapies on patient outcomes.…”