Treatment of hypercholesterolemia with ezetimibe in the kidney transplant population

Background. Given the high incidence of lipid abnormalities, high burden of cardiovascular disease, and high proportion who do not achieve target levels despite therapy in the kidney transplant population, additional lipid lowering strategies are needed. Methods. This was a nonrandomized, open-label, single-cohort evaluation of ezetimibe, a novel cholesterol absorption inhibitor, in 40 stable kidney transplant recipients with hypercholesterolemia. Results. After 4 weeks of therapy total and LDL cholesterol were reduced by 23 +/- 13% (P < .0001.) and 33 +/- 15% (P < .0001), respectively. The drug was equally effective in patients on cyclosporine (19), tacrolimus (13), or sirolimus (8), but more effective (P = .0006) when used in combination with a statin (41 13% reduction in LDL, n = 22) compared with monotherapy (24% +/- 13%, n = 1.8). There were no significant effects on serum creatinine, drug levels, body weight, or liver function tests. Conclusions. Ezetimibe is an effective LDL cholesterol-lowering agent in the kidney transplant population. Further studies are warranted in a larger population not only to examine the extent of cardiovascular risk reduction but also to detect unwarranted toxicity.