Fluvastatin in the prevention of renal transplant vasculopathy:: Results of a prospective, randomized, double-blind, placebo-controlled trial

Background. Statins prevent the progression of transplant vasculopathy in heart transplants, but its beneficial effect on the transplanted kidney is controversial. Methods. The aim is to evaluate the utility of fluvastatin 80 mg/day to reduce the progression of 6-month renal transplant vasculopathy in a multicenter, prospective, randomized, placebo-controlled trial stratified according to donor age. All patients received cyclosporine, mycophenolate mofetil, and prednisone. The progression of transplant vasculopathy was evaluated in paired donor and 6-month protocol biopsies. The primary efficacy variable was the progression of mean arterial intimal volume fraction (delta Vvintima/artery) evaluated with histomorphometry. The minimum sample size to detect a 50% reduction in the progression of delta Vvintima/artery was 62 patients per group. The secondary efficacy variable included the incidence of transplant vasculopathy evaluated according to Banff criteria. Results. A total of 89 patients were included, 74 completed the 6-month study and 57 have paired biopsies with sufficient tissue for histological evaluation. The delta Vvintima/artery was not different between treatment and placebo groups (6.9 +/- 8.2% vs. 6.9 +/- 7.4%, P = ns), whereas the incidence of transplant vasculopathy was lower in the fluvastatin group (7% vs. 33%; P = 0.02). Because there was a discrepancy between the primary and secondary efficacy variables, post hoc analysis was performed to evaluate the reproducibility of both variables in a subset of 50 biopsies. The reproducibility of transplant vasculopathy was higher than the reproducibility of Vvintima/artery (kappa 0.86 vs. 0.33). Conclusions. In summary, there were no differences in delta Vvintima/artery between groups, but fluvastatin treatment was associated with a reduced incidence of transplant vasculopathy.