Statin Therapy Associated With a Reduced Risk of Chronic Renal Failure After Cardiac Transplantation

Background: Chronic renal failure (CRF) after heart transplantation is common, although risk factors for its development and potential preventive interventions are not well established. Methods: In this study we retrospectively assessed the cumulative incidence of CRF and identified independent predictors of CRF in heart transplant recipients between August 1986 and January 2003. Results: Among the 218 patients included in the analysis, the cumulative incidence of CRF was 4.5% at 5 years, and 19.6% at 10 years after transplant. Multivariate Cox modeling revealed that diabetes mellitus prior to transplant was associated with an increased risk of CRF (hazards ratio [HR] 7.11, p < 0.01), whereas factors associated with a reduced risk of CRF included a pre-transplant creatinine clearance ≥60 ml/min/1.73 m² (HR 0.30, p = 0.01) and treatment with a statin after transplant (HR 0.25, p < 0.01). Patients who developed CRF after transplant were at higher risk of death (HR 8.5, p < 0.01). Conclusions: CRF is common after cardiac transplantation and is associated with substantial mortality. The reduced risk of CRF observed with statin therapy warrants prospective study, with particular emphasis on the mechanisms of progression to CRF in this population.