#3934 safety and efficacy of evolocumab among kidney transplant patients at high cardiovascular risk

Abstract Background and Aims Proprotein convertase subtilisin/Kexin type A(PCSK-9) inhibitors have not been evaluated among kidney transplant recipients (KTR) despite its favorable cardiovascular profile. We aimed to evaluate the safety and efficacy of evolocumab in reducing lipids and cardiovascular events among risky KTR. Method One hundred ninety-five KTR - who were followed up in Hamed Al-Essa organ transplant center with high cardiovascular risk score (>20)-were enrolled in this prospective randomized controlled study between June 2017 and June 2018. Patients who received statin and evolocumab (140 mg/ 2 weeks, group1, n = 97) while those maintained on statin alone comprised group 2(n = 98). After 24 months, they were followed up clinically and by laboratory investigations. Results The two groups had comparable demographics. Before enrollment in the study, we observed a higher prevalence of NODAT in group 2 and more smokers in group 1(p < 0.05). Basal graft function was significantly higher in group 1, while the type of immunosuppression was equivalent in both groups(p > 0.05). We found no significant differences between the two groups concerning cardiovascular events, and both graft and patient outcomes (p > 0.05). Despite the comparable triglycerides levels, we found significantly higher basal cholesterol in group 1(5.5 vs. 4.7, p < 0.001), which came down significantly in the same group after three months and thereafter (p = 0.031) compared to group 2 and basal values (p < 0.001). We reported 2 cases of acute MI and one atrial fibrillation in group2. Conclusion Evolocumab is a promising lipid-lowering agent among risky KTR. Earlier cholesterol reduction was observed in group 1 without significant positive cardiovascular impact.