Risk of Statin-Related Side Effects in Kidney Transplant Recipients

S. Bae¹, J. Ahn¹, K. Lentine², M. A. Schnitzler², G. Hess³, H. Xiao², D. Segev¹, M. McAdams DeMarco¹

¹Johns Hopkins University, Baltimore, MD, ²Saint Louis University, Saint Louis, MO, ³Drexel University, Philadelphia, PA

Meeting: 2021 American Transplant Congress

Abstract number: 894

Keywords: Safety

Topic: Clinical Science » Kidney » Kidney: Cardiovascular and Metabolic Complications

Session Information

Session Name: Kidney: Cardiovascular and Metabolic Complications

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: Statins are widely used in kidney transplant (KT) recipients for prevention of cardiovascular events. Statins’ safety profile may differ in KT recipients due to their chronic comorbidities and concomitant immunosuppression. We conducted a national registry study to measure the association of statin use with the statin-related side effects in KT recipients.

*Methods: We studied 101,460 adult (≥18) kidney-only recipients with Medicare Parts A, B, and D coverage in 2006-2016 using USRDS data. Use of statins was ascertained from Medicare Part D prescription drug claims and treated as a time-varying exposure. Statin-related side effects, including hemorrhagic stroke, type 2 diabetes, cataract, liver injury, and rhabdomyolysis, were ascertained from ICD-9/-10 diagnosis and procedure codes, and CPT codes in Medicare Parts A and B claims. After excluding recipients with diagnoses of the specific side effect during 30 days prior to KT, we conducted Cox regression for each side effect.

*Results: The proportions of statin users were 29.6% at KT and 44.7% at 5 years post-KT. Type 2 diabetes was the most common side effect (5-year incidence=22.8%), followed by cataract (11.6%), liver injury (1.8%), hemorrhagic stroke (1.3%), and rhabdomyolysis (0.9%). Compared to non-users, statin users were at higher risk of type 2 diabetes (aHR=_1.781.87_1.96), cataract (aHR=_1.571.65_1.74), and rhabdomyolysis (aHR=_1.211.42_1.68). The risk of hemorrhagic stroke (aHR=_0.700.81_0.94) and liver injury (aHR=_0.901.02_1.16) was not higher in statin users after adjustments.

*Conclusions: Statins might increase the risk of type 2 diabetes, cataract, and rhabdomyolysis in KT recipients, potentially to a greater degree than they do in the general population. On the other hand, unlike the general population, KT recipients may not experience increased risk of hemorrhagic stroke or liver injury following statin use.

Table. Association of statin use with statin-related side effects in kidney transplant recipients
	Model 1 (Unadjusted)	Model 2(M1 + recipient)	Model 3 (M2 + IS)	Model 4 (M3 + donor)
Hemorrhagic stroke	1.20 (1.05 – 1.38)	0.85 (0.74 – 0.98)	0.84 (0.73 – 0.97)	0.81 (0.70 – 0.94)
Type 2 diabetes	2.39 (2.29 – 2.50)	1.94 (1.85 – 2.03)	1.92 (1.83 – 2.01)	1.87 (1.78 – 1.96)
Cataract	2.41 (2.30 – 2.54)	1.68 (1.59 – 1.76)	1.67 (1.59 – 1.76)	1.65 (1.57 – 1.74)
Liver injury	1.16 (1.03 – 1.31)	1.05 (0.92 – 1.20)	1.05 (0.92 – 1.20)	1.02 (0.90 – 1.16)
Rhabdomyolysis	1.87 (1.60 – 2.19)	1.48 (1.25 – 1.74)	1.46 (1.24 – 1.72)	1.42 (1.21 – 1.68)

To cite this abstract in AMA style:

Bae S, Ahn J, Lentine K, Schnitzler MA, Hess G, Xiao H, Segev D, DeMarco MMcAdams. Risk of Statin-Related Side Effects in Kidney Transplant Recipients [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/risk-of-statin-related-side-effects-in-kidney-transplant-recipients/. Accessed May 11, 2025.

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