*Purpose: Cardiovascular disease (CVD) is the leading cause of mortality in adult survivors of pediatric kidney transplantation. This study describes the prevalence of hyperlipidemia and its treatment in a large pediatric kidney transplant population following the implementation of a clinical practice guideline in June 2015.

*Methods: A retrospective review of prevalent pediatric kidney transplant recipients with an outpatient visit between January 1, 2016 and December 31, 2018 was performed. Patient and transplant demographics, pertinent lab values, medications, and incidence of adverse effects were collected. Hyperlipidemia was defined as two LDL levels exceeding 130 mg/dL or active treatment with a lipid-lowering agent. We evaluated the following risk factors for hyperlipidemia: BMI, hypertension, diabetes, or medications known to contribute to hyperlipidemia.

*Results: A total of 1,269 lipid panels from 239 kidney transplant recipients were reviewed. Patient demographics are shown in Table 1 with 59 (24.7%) patients meeting criteria for hyperlipidemia. Patients prescribed mTOR inhibitors (OR 7.59, 95% CI 3.95-14.6) or treatment for diabetes (OR 7.14, 2.33-21.87) were more likely to have hyperlipidemia. Neither obesity nor hypertension were significant risk factors for elevated LDL. ALT elevation was more prevalent in the hyperlipidemia group (22% vs 10.6% p=0.025). Among those with hyperlipidemia, 63% (n=37) received treatment with a statin for a median of 837 days and 3% (n=2) were treated with fish oil monotherapy. Patients on statin therapy had a lower median LDL (117 vs 134 mg/dL; p = 0.019) and were more likely to have LDL <130 mg/dL at the date of last follow up (78.3% vs 40%, p=0.004) compared to patients receiving no treatment. Overall, statin therapy was well tolerated without significant side effects. Of the 20 patients without pharmacologic intervention for hyperlipidemia, 20% (n=4) were too young for statin therapy and the remainder were adolescents and young adults.

*Conclusions: Hyperlipidemia is relatively common in children with kidney transplant. Modifiable risk factors for hyperlipidemia identified included use of mTOR inhibitors and diabetes in our cohort. Statin therapy effectively controlled hyperlipidemia in the majority of patients and was well tolerated. Additional endeavors will focus on evaluating barriers to statin therapy including concern for additional pill burden in adolescent and young adults with hyperlipidemia at our center.

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