Table 1.
Methodological characteristics of the included studies
| Study | Design | Country | Sample size | Statin | Time from Tx † | Age (years)† | Male sex (%) | DM (%) | HTN (%) | BMI (kg/m2) † | eGFR (ml/min/ 1.73 m2) † |
LDL-C (mmol/L) † |
CVD (%) |
CNI (%) |
mTORi (%) | Follow-up (months) † |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 2024; Nazoiri [54] | RC | France | 318 | Low-intensity: 58.3%; Moderate-intensity: 68.6%; High-intensity: 11.5% | 12.1 months | 45.7 | 64.2 | 7.5 | 88.1 | 23.8 | 52 | 2.60 | 0 |
CsA: 23.3 Tacrolimus: 76.4 |
1.9 | 72 |
| 2024; Yim [55] | PC | South Korea | 714 | Any | Up to 12 months | 45.6 | 64.1 | 25.5 | 92.4 | 22.8 | 72.6 | 2.16 | 8.4 |
CsA: 5.3 Tacrolimus: 94.7 |
7.1 | 84 |
| 2023b; Bae-USRDS [53] | RC | USA | 58,264 | Simvastatin: 46.9%; Atorvastatin: 45.2%; Pravastatin: 14.5%; Rosuvastatin: 9.7% | NR | 51.4 | 60.3 | 35.3 | NR | 27.5 | NR | NR | NR |
CsA: 4.4 Tacrolimus: 91.8 |
3.1 | 36 |
| 2023a; Bae-USRDS [52] | RC | USA | 57,699 | Simvastatin: 46.9%; Atorvastatin: 45.2%; Pravastatin: 14.5%; Rosuvastatin: 9.7% | NR | 51.1 | 60.4 | 35.3 | NR | 27.5 | NR | NR | NR |
CsA: 4.3 Tacrolimus: 90.2 |
3.0 | 36 |
| 2021; Anderson [51] | RC | Germany | 622 | Atorvastatin: 65.2%; Simvastatin: 20.8%; Fluvastatin: 5.2%; Rosuvastatin: 4.8%; Pravastatin: 4.4% | > 12 months | 53.9 | 57.2 | 23.2 | NR | 26.6 | NR | 2.98 | 14.8 |
CsA: 39.5 Tacrolimus: 18.8 |
0 | 64.8 |
| 2022; Frasco [50] | RC | USA | 1384 | Atorvastatin: 54.3%; Rosuvastatin: 18.8%; Simvastatin: 12.1%; Pravastatin: 12.1% | Post-transplant | 54 | 57.9 | 37.1 | NR | 27.5 | NR | NR | NR | Tacrolimus: 100 | 1.2 | 12 |
| 2020; Szili-Torok [49] | PC | Netherlands | 190 | Atorvastatin: 52.6%; Fluvastatin: 27.4%; Simvastatin: 14.7%; Pravastatin: 5.3% | 78 months | 50.3 | 50.2 | 0 | 82 | 24.9 | 50.8 | 3.5 | NR |
CsA: 66.4 Tacrolimus: 8.2 |
0 | 115.2 |
| 2017; Han [48] | RC | South Korea | 165 | Any | 6.7 months | 47.4 | 55.2 | 17.6 | 92.7 | 21.0 | NR | NR | 15.8 | Tacrolimus: 100 | 0 | 60 |
| 2017; Vangala-USRDS [4] |
Nested C-C |
USA | 15,806 | Any | 55.6 months | 51.2 | 59.6 | 74.6 | NR | 27.3 | NR | NR | 75.3 |
CsA: 18.5 Tacrolimus: 62.8 |
9.9 | 12 |
| 2014; Choe [46] | RC | South Korea | 394 |
Atorvastatin (20 mg):45.3%; Fluvastatin (80 mg): 54.7 |
NR | 40.1 | 58.4 | 0 | 72.1 | 22.0 | 62.5 | NR | NR |
CsA: 34.8 Tacrolimus: 67.0 |
0 | 60 |
| 2010; Younas [70] | RC | USA | 615 | Any | Up to 12 months | 50 | 63 | 16.9 | NR | 26 | NR | 2.65 | 7.2 |
CsA: 0.3 Tacrolimus: >90% |
8.5 | 79.7 |
| 2008; Wiesbauer [69] | RC | Austria | 2041 | Any | NR | 48 | 59.9 | 18.8 | 81.1 | NR | NR | NR | 67.1 | NR | NR | 144 |
| 2008; Seron [68] | RCT | Spain | 89 | Fluvastatin (80 mg) | Post-transplant | 42 | 57.3 | 0 | NR | NR | NR | NR | 0 | CsA: 100 | 0 | 72 |
| 2007; Lisik [67] | RC | USA | 325 | Pravastatin: 73.3%; Atorvastatin: 25%; Simvastatin: 2% | Up to 3 months | 44.9 | 60 | NR | NR | NR | NR | NR | NR | CsA: 100 | 100 | 75 |
| 2007; Lopau [66] | C-C | Germany | 150 | Pravastatin (29.7 mg†) | 4 days | 48.5 | 66.7 | 18 | NR | NR | 62.9 | 3.75 | NR | CsA: 100 | 0 | 48 |
| 2004; Prasad [65] | RC | Canada | 314 | Atorvastatin: 85%; Pravastatin: 7%; Simvastatin: 4%; Fluvastatin: 4% | NR | 44.6 | 56.8 | 0 | NR | NR | NR | 2.24 | NR |
CsA: 58.7 Tacrolimus: 41.3 |
0 | 36 |
| 2004; Fellström-ALERT [60] | RCT |
Inter- national |
2102 | Fluvastatin (40 mg) | 62.4 | 49.8 | 66 | 18.8 | 74.9 | 25.8 | 60.3 | 4.1 | 23.5 | CsA: 100 | NR | 61.2 |
| 2001; Holdaas [57] | RCT |
Inter- national |
364 | Fluvastatin (40 mg) | Post-transplant | 48.4 | 71.4 | 12.4 | NR | NR | NR | 2.98 | NR | CsA: 100 | 0 | 3 |
| 1999; Lepre [45] | RCT | Australia | 49 | Simvastatin (10 mg) | > 12 months | 51.4 | 34.7 | 14.3 | 77.6 | NR | NR | 4.63 | NR | CsA: 57.1 | 0 | 9 |
| 1996; Katznelson [40] | RCT | USA | 48 | Pravastatin (20 mg) | 7 days | 47.3 | 69 | NR | NR | NR | NR | NR | NR | CsA: 100 | 0 | 4 |
| 2002; Cosio [63] | RC | USA | 1574 | Any |
< 24 months: 32.4% 24–60 months: 20% |
42 | 59 | 22 | NR | 26 | NR | NR | NR | CsA: 100 | 0 | 98.4 |
| 2010; Moreso [62] | RC | Spain | 3682 | Any | NR | 46.5 | 63.1 | 5.3 | NR | NR | NR | NR | NR |
CsA: 70 Tacrolimus: 20.9 |
NR | 180 |
| 1994; Arnadottir [61] | RCT | USA | 40 | Simvastatin (10 mg) | 50 | 51.5 | 65 | 20 | NR | 25.3 | NR | 5.45 | NR | CsA: 100 | 0 | 4 |
| 2005; Holdaas-ALERT [58] | RCT |
Inter- national |
1652 | Fluvastatin (40 mg) | 62.4 | 48.5 | 66.3 | 16.9 | 74.6 | 26 | 60.3 | 4.1 | 23.5 | CsA: 100 | NR | 72 |
| 2003; Holdaas-ALERT [56] | RCT |
Inter- national |
2102 | Fluvastatin (40 mg) | 62.4 | 49.8 | 66 | 18.8 | 74.9 | 25.8 | 60.3 | 4.1 | 23.5 | CsA: 100 | NR | 72 |
| 2001; Santos [60] | RCT | Brazil | 67 | Simvastatin (10 mg) | 60.5 | 43.3 | 44.8 | NR | NR | NR | 65.9 | 4.67 | NR | CsA: 77.6 | 0 | 57.5 |
| 2001; Kasiske [59] | RCT | USA | 105 | Simvastatin (10 mg) | Post-transplant | 46.5 | 59 | NR | NR | NR | NR | NR | NR | CsA: 100 | 0 | 3 |
†Median values. RC: retrospective cohort; PC: prospective cohort; C-C: case-control; RCT: randomized controlled trial; DM: diabetes mellitus; HTN: hypertension; BMI: body mass index; CNI: calcineurin inhibitor; mTORi: mammalian target of rapamycin inhibitor; CsA: cyclosporine; eGFR: estimated glomerular filtration rate; LDL-C: low-density lipoprotein cholesterol; CVD: cardiovascular disease; Tx: transplantation; ALERT: Assessment of Lescol in Renal Transplant; USRDS: United States Renal Data System; NR: not reported