Statin Use Is Associated with Prolonged Survival of Renal Transplant Recipients

Abstract

The efficacy of statins for the prevention of cardiovascular events is well established in the general population but remains unknown in renal transplant recipients. In this study, the association of statin use with patient and graft survival was investigated in a cohort of 2041 first-time recipients of renal allografts between 1990 and 2003. Multivariable Cox regression demonstrated that statin use was independently associated with lower mortality rates. Twelve-year survival rates were 73% for statin users and 64% for nonusers (P ϭ 0.055). The adjusted hazard ratio for all-cause mortality associated with statin use was 0.64 (95% confidence interval 0.48 to 0.86). Graft survival rates during the same time period were 76% for statin users and 70% for nonusers (P ϭ 0.055). The adjusted hazard ratio for graft survival associated with statin use was 0.76 (95% confidence interval 0.55 to 1.04). Results from marginal structural models were virtually identical. In summary, statin use was associated with prolonged patient survival, but no difference in graft survival was detected. Although these results are encouraging, a definitive causal relationship can be determined only from randomized clinical trials.

Statin Use Prolongs Patient Survival after Renal Transplantation

“…Indeed, physiologic activation of the UPR often selectively enhances the prosurvival aspects of the response. 16 This pattern is consistent with adaptive versus terminal UPR activation and seems…”

“…The good news in the article by Wiesbauer et al 16 is statin use in this nonrandomized registry population had a beneficial effect, a welcome addition to the results of the presumably underpowered prospective ALERT study, in which the primary end point was negative but the post hoc analyses of subgroups yielded positive results. 5 The bad news is such observational data have important limitations.…”

“…14 The surprising magnitude of the effect might have been influenced by co-medication with cyclosporine, which in a recent study reduced acute infarction size. 15 Wiesbauer et al 16 in this issue of JASN assessed a total of 2041 kidney graft recipients-all patients who underwent transplantation between 1990 and 2003. Of these registry patients, 302 used statins at baseline and 1739 did not.…”

“…Impressively, despite more comorbidity and longer time on dialysis, mortality was lower. Nevertheless, hidden confounders (not accounted for by the multivariate model: Statin treatment before transplantation or discontinuation of treatment) might theoretically have an impact in the registry sample 16 ; that is, any unknown effect including unquantifiable bias of indeterminate direction and origin may influence the result. Because of the lack of randomization, registry data do not definitely prove causality of statin treatment.…”

Cardiac Disease Evaluation and Management Among Kidney and Liver Transplantation Candidates

“…241 A large, observational cohort study of 2041 consecutive, first-time kidney transplant recipients at 1 center in Austria in 1990 to 2003 used pharmaceutical and death records to examine survival in relation to statin use in a time-dependent regression analysis. 246 The study estimated a 36% relative reduction in adjusted mortality over up to 12 years of follow-up in statin-treated patients (adjusted HR, 0.64; 95% CI, 0.48 to 0.86).…”