PCSK9 inhibitors: a promising lipid-lowering strategy for kidney transplant recipients

Sep 30, 2026

Recent advancements in transplant techniques and immunosuppressive drugs have improved long-term survival after kidney transplantation, but post-operative dyslipidemia has become a major complication. Dyslipidemia drives atherosclerotic cardiovascular disease, the leading cause of renal function loss and mortality, and is not adequately controlled for many patients with statins due to drug interactions, adverse effects, and renal impact. PCSK9 inhibitors have shown promise in general cardiovascular populations, yet evidence in transplant recipients remains limited. This article reviews mechanisms, metabolism, clinical applications, efficacy, and safety.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages22

Reading Time55 min

AccessFree to download

Introduction

Clinical context: post-transplant dyslipidemia and cardiovascular risk

Limitations of statins in transplant recipients

Rationale for PCSK9 inhibitors in this population

Abstract and scope of the review

Renal FailuRe 2025, VOl. 47, nO. 1, 2604881 [https://doi.org/10.1080/0886022X.2025.2604881](https://doi.org/10.1080/0886022X.2025.2604881) State of the art review PCSK9 inhibitors: a promising lipid-lowering strategy for kidney transplant recipients Bohan Luoa,b\#, Ling Guoa\# and wenjia Dib aSchool of Medicine, university of electronic Science and Technology of China, Chengdu, China; bOrgan Transplantation Center, Sichuan Provincial People’s Hospital, university of electronic Science and Technology of China, Chengdu, Sichuan, China ABSTRACT recent advancements in transplant techniques and immunosuppressive drugs have improved long-term survival rates and increased the age of transplant recipients. Dyslipidemia has become a major complication, leading to atherosclerotic cardiovascular disease as the primary cause of renal function loss and mortality, surpassing rejection. although statins are the first-line treatment, many patients face limitations due to drug interactions, side effects, and renal function impacts, resulting in suboptimal lipid control and limited clinical benefits. thus, there is a clear need for alternative lipid-lowering treatments for kidney transplant recipients. Proprotein convertase subtilisin/kexin type 9 (PCSK9)inhibitors have shown promise in cardiovascular disease management in the general population, but research on their use in kidney transplant patients is limited to case reports and small-scale studies. this article reviews the progress of PCSK9 inhibitors in lipid management for these patients, discussing their mechanisms, metabolism, clinical applications, efficacy, and safety, while providing insights for future research and clinical practice to enhance blood lipid management guidelines and improve the quality of life and survival rates of kidney transplant recipients. 1. Introduction ARTICLE HISTORY received 6 June 2025 revised 12 November 2025 accepted 5 December 2025 KEYWORDS PCSK9 inhibitors; kidney transplantation; lipid management; clinical applications; research progress Kidney transplantation is an important means of saving the lives of patients with end-stage renal disease and can significantly improve patient prognosis. however, the metabolic challenges that follow, particularly post-operative dyslipidemia, have become a primary threat to the long-term quality of life and cardiovascular health of these patients. Current research indicates that the prevalence of dyslipidemia after kidney transplantation is as high as 80%[1] . according to data from the US renal Data System in 2024, 32% of patients die from cardiovascular disease, and all cardiovascular events account for 20.6% of all-cause mortality, making them the leading cause of death among all known causes of death [2] . hyperlipidemia is the main risk factor of atherosclerotic cardiovascular disease (aSCvD), so dyslipidemiais bound to be closely related to the incidence of cardiovascular events [3,4] . it is important to acknowledge that kidney transplant recipients are inherently exposed to multiple non-modifiable risk factors, including advanced age, baseline function of the allograft, preoperative dialysis vintage, and pre-transplant hyperphosphatemia. Nevertheless, a notable opportunity for intervention exists: postoperative dyslipidemia in these patients can still be substantially ameliorated through the implementation of proactive and individualized lipid management strategies. therefore, effective monitoring and intervention of dyslipidemia in kidney transplant recipients is a fundamental approach to reducing the occurrence of cardiovascular events. the all-cause mortality of patients after kidney transplantation is shown in figure 1. CONTACT Wenjia Di [2721246993@qq.com](2721246993@qq.com) Organ Transplantation Center, Sichuan Provincial People’s Hospital, university of electronic Science and Technology of China, Chengdu, 610072, Sichuan, China. \#These authors have contributed equa

FAQs

Why is dyslipidemia a major issue after kidney transplantation?

Post-operative dyslipidemia threatens long-term quality of life and cardiovascular health. It is strongly linked to atherosclerotic cardiovascular disease and associated mortality.

What limits the effectiveness of statins for kidney transplant recipients?

Statins are first-line therapy, but their use is restricted by interactions with immunosuppressants, potential liver and kidney function impacts, and side effects such as muscle pain and diabetes, making optimal lipid control difficult.

What is the main mechanism of PCSK9 inhibitors?

PCSK9 inhibitors reduce LDL-C by inhibiting PCSK9 function, which increases the number of LDL receptors on liver cell surfaces.

Sep 30, 2026

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