Death with a functioning graft remains one of the two most important causes of reduced long-term renal transplant survival. Since cardiovascular disease remains the most frequent cause of patient death, strategies to reduce atherosclerosis are becoming an increasingly important part of post-transplant management. It has also been suggested that treatment of hyperlipidemia might improve graft survival by reducing chronic allograft nephropathy. The ALERT study was a randomized controlled double blind trial of statin therapy versus a placebo carried out in over 2,000 patients, followed for seven years. The results show an approximate 30% reduction in major adverse coronary events (p=0.036) associated with a fall in LDL cholesterol of approximately 1 mM. However, no improvement in allograft functional graft survival was seen. Nevertheless, the use of Fluvastatin in this study was remarkably safe. Thus in renal transplant recipients should be treated to lower cholesterol with statins. The optimal target LDL cholesterol level will be discussed. While a large randomized control trial has also been conducted to assess the effect of statin therapy on renal transplant rejection, it unfortunately failed to document any reduction.
The various treatment options for reducing both cholesterol as well as triglycerides will be discussed, including potential interactions with calcineurine inhibitors.