PSHP 2026 Residency Conference

Purpose: The purpose of this retrospective study is to evaluate the appropriateness and effectiveness of low-intensity pravastatin 20 mg daily in statin-naïve, kidney transplant recipients, according to the estimated baseline ASCVD risks.
Methods: The study includes a chart review of 296 subjects who underwent kidney transplants between September 1, 2023, and September 1, 2024, with at least 12 months of post-transplant follow-up. Baseline demographics that are pertinent to estimate ASCVD risk are included. Transplant data was collected, including transplant indication, lipid profiles, and incidence of delayed graft function. Goal statin intensity was extrapolated based on age, history of diabetes mellitus, chronic kidney disease, tobacco use, coronary calcium scores (when available), and calculated ASCVD scores. ASCVD risk scores were assessed using the American College of Cardiology online calculator. Pravastatin initiation and monthly continuation were recorded. If pravastatin discontinuation occurred within 12 months, timing, reason for discontinuation, and intensity changes were further assessed. Information on immunosuppressive therapy was also collected.
Results: A total of 296 patients were evaluated, and 60 patients were included for analysis. The 10-year ASCVD risk was estimated for 24 (40%) patients. Low-intensity pravastatin was appropriate in 35 (58%) patients. The median changes in LDL, HDL, and total cholesterol levels from day 30 to 365 post-transplant were 7.5 mg/dL, 1.5 mg/dL, and 10 mg/dL, respectively (all p-value>0.05). Approximately 51 (85%) patients continued pravastatin throughout one year post transplant. Four (6.7%) discontinued pravastatin due to reported intolerance or self-discontinuation; no patients met clinical criteria for hepatoxicity and rhabdomyolysis. One (1.7%) experienced non-fatal myocardial infarction (MI); however, no patients experienced ischemic stroke. 
Conclusion: We estimated that more than a third of patients might be considered for a higher intensity statin based on baseline characteristics, estimated risk assessment, and ASCVD risk enhancers. Most patients remained on low-intensity pravastatin for up to one-year post-transplant. Changes in lipid profile from 30 days to 365 days were not significant. No major safety issues were observed, except for non-fatal MI.