USE OF HMG-COA REDUCTASE INHIBITORS AFTER KIDNEY AND HEART-TRANSPLANTATION - LIPID-LOWERING AND IMMUNOSUPPRESSIVE EFFECTS

Hypercholesterolaemia is common in patients treated with cyclosporin a fter kidney and heart transplantation; coronary vasculopathy, graft at herosclerosis or cardiovascular complications are the most frequent ca uses of mortality. Coronary heart disease has been attributed to hyper cholesterolaemia and has been identified as a major risk factor of lon g term graft outcome in patients after kidney transplantation. HMG-CoA reductase inhibitors have been proven to be effective in lowering ser um cholesterol concentrations in kidney and heart graft recipients rec eiving long term cyclosporin immunosuppression, and are therefore the drugs of choice in patients requiring treatment for hypercholesterolae mia after organ transplantation. The hydrophilic HMG-CoA reductase inh ibitors, such as pravastatin and fluvastatin, should be distinguished from the lipophilic agents, lovastatin and simvastatin, with regard to toxicity and accumulation. Maximal doses of drugs in the latter group should be avoided, whereas the former have been administered at high dosages over prolonged periods of time without adverse effects. Recent preliminary data indicate that treatment with pravastatin not only de creases serum cholesterol but may have beneficial effects on the incid ence, recurrence and severity of rejection episodes after kidney and h eart transplantation.