*Purpose: Cardiovascular disease is the main cause of death among patients with end-stage renal disease (ESRD). Statin, HMG-CoA reductase inhibitor, is well known to significantly reduce cardiovascular risk in patients with chronic kidney disease (CKD), therefore current guidelines recommend statin use in CKD patients with good evidence level. However, it remains unclear whether statin use can reduce major cardiovascular event (MACE) occurrence in kidney transplantation (KT) recipients.

*Methods: We analyzed a nationwide health insurance database of South Korea and identified patients who had KT from the year of 2010 to 2017. Patients who were under 19 years of age, had previous MACE events identified, or had received statins within one year before inclusion were excluded from the study. Patients were divided into two groups: recipients prescribed statin within one year after KT (statin group), and those were not (control group). The main outcome was the development of MACE after 1 year of KT.

*Results: A total of 14,350 patients received KT and 4,348 were finally enrolled after exclusion. Among them, only 40% (1,745) of patients were prescribed any kind of statin. Statin users were older, more women, more hypertensive and diabetic than statin non-users. In addition, they received preemptive KT more, and had shorter dialysis duration. During follow-up, only 100 KT recipients developed new MACE events including 26 myocardial infarction, 41 revascularization, and 56 ischemic stroke. The overall MACE incidence in the statin group was not different from statin non-user group (HR 0.69 (0.42-1.13) P = 0.1399). Also, there was no significant difference between the statin group and control when comparing myocardial infarction, revascularization, and ischemic stroke (HR 0.76 [0.30-1.94] P= 0.5696, HR 1.11 [0.57-2.18] P=0.7476, and HR 0.94 [0.50-1.78] P=0.8616, respectively.).

*Conclusions: Because of small number of MACE events in South Korea, we could not conclude whether the use of statin in KT recipients reduce MACE or not. Further research is needed to provide evidences for lipid management guidelines in KT patients.

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