Safety of Concomitant Use of Tacrolimus and High-Intensity Statins in Liver and Kidney Transplant Recipients.

Due to increased risk of myalgia and rhabdomyolysis associated with the use of simvastatin with cyclosporine, use of high-intensity 3-hydroxy-3-methylglutaryl Coenzyme A reductase inhibitors (statins) is often avoided in transplant recipients. Aim: This program evaluation aimed to determine the safety of high-intensity statins in liver and kidney transplant recipients taking tacrolimus.

Design

All liver and kidney transplant recipients who filled prescriptions for tacrolimus and any statin except for simvastatin between June 15, 2020 and July 22, 2022 were screened for inclusion. High-intensity was defined as atorvastatin 40 or 80 mg, or rosuvastatin 20 or 40 mg. The primary outcome was a composite of statin-related myalgia, statin-related rhabdomyolysis, and creatine kinase above the upper limit of normal. Secondary outcomes included liver function tests above 3 times the upper limit of normal, statin discontinuation, and statin dose decrease and associated reason.

Results

A total of 178 recipients were included, with 100 receiving low-to-moderate-intensity statins and 78 receiving high-intensity statins. There were no differences between groups for statin-related myalgia, and no reported cases of statin-related rhabdomyolysis in either group. Low to moderate intensity statin use was associated with an increased rate of liver function test elevation (26% vs 11.5%, P = .014) occurring a median of 306 days (interquartile range [IQR] 134-725) post-statin initiation.

Conclusion

In liver and kidney transplant recipients receiving tacrolimus, the use of high-intensity statins was not associated with an increased risk of myalgia, rhabdomyolysis, or elevated creatinine kinase when compared with low-to-moderate-intensity statin use.