Cholesterol medication after kidney transplant

Posted by caretakermom @caretakermom, Sep 5, 2023

Hi fellow kidney transplant members/caretaker,

My husband is taking Everolimus as one of his immunosuppressant drugs and one of its most common side effects is hyperlipidemia(high cholesterol). He recently saw his cardiologist and even though his LDL is below 100, his cardiologist wants it to be around 70 because he "has a history of cardiovascular disease". Just as background, my husband had an angioplasty prior to getting his kidney transplant. LDL was around 40 which is well below 100 pre kidney transplant. However, since taking Everolimus LDL has gone up, though still below 100 which the neph AND transplant are OK with. His cardiologist though wants to double his current med(Atorvastatin) from 10mg to 20mg. At the time of the appointment with the cardiologist I totally forgot about the side effects of Everolimus and didn't mention it to him. My issue with the increase of the cholesterol med may interfere with the immuno drugs and/or possibly may increase AST and ALT, liver enzymes. The cardiologist says hubby can also try Pravastatin, commonly taken by transplant patients though not as "strong" as Atorvastatin so may have to increase dosage relative to Atorvastatin. Again, my concern here is how is this going to effect immunosuppressant therapy and/or other labs. Cardiologist says to talk to nephrologist(who will decide which statin if that) since he is managing most of hubby's meds.
Will definitely bring up this issue with nephrologist at next appointment in 2 weeks.
I'm wondering what your thoughts are. Did you change your statin meds post transplant? Would you be amenable to change your cholesterol meds(cholesterol is higher due to immunosuppressant drug) knowing that this change may dynamically change your immunosuppressant therapy? I'm concerned this may cause other issues when drug therapy is disturbed!!!
P.S. I remember our nurse coordinator mentioned that they have patients whose cholesterol went up to 300 due to taking Everolimus!! Looking forward to you input as always. Thank you in advance.

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Cheryl, Volunteer Mentor | @cehunt57 | Sep 6, 2023

@caretakermom my background is pancreas transplant in 2005 and stage 4 chronic kidney disease (CKD). My providers also want me to have a lower LDL than normally required and a higher HDL than normally required. I too have immune suppression medication. All medication has side effects. If you have several conditions and more than one medication there starts to be medication interactions to be concerned about. It helps to have the various prescribing providers under one roof so to speak. That way collaboration can happen and everyone is on the same page. It sounds like your husband’s cardiologist and nephrologist are doing this. You said that you plan to bring up your concerns at the next appointment in 2 weeks. That is excellent. Providers should not be threatened by questions. They should welcome the reminder to consider all the pros and cons of a particular medication or treatment so that the patient’s needs can be prioritized.