Impact and management of hyperlipidemia posttransplantation.

CVD morbidity and mortality is a major cause of premature death and allograft loss in recipients of renal and cardiac transplants, and hyperlipidemia--a major risk factor for CVD in the general population--may be a significant risk factor for CVD in transplant recipients. Hyperlipidemia is common after transplantation, and immunosuppression with corticosteroids, cyclosporine, or sirolimus causes posttransplantation hyperlipidemia. Posttransplantation hyperlipidemia can be treated in various ways, but statin therapy has thus far proved to be the most effective in lowering lipid levels in the transplant population. However, to date, no large solid end-point studies have demonstrated that lipid-lowering therapy with statins (or any other class of agents) significantly reduces CVD morbidity or mortality and improves allograft survival in transplant recipients, although some smaller studies point in that direction. The ongoing ALERT trial is currently studying whether early and later intervention with a statin (fluvastatin) can reduce chronic allograft dysfunction, decrease CVD, and improve patient survival in transplant recipients.