An increased incidence of hyperlipidemia places kidney graft recipients at increased risk for cardiovascular disease and may contribute to a decline in graft function. A study was undertaken to evaluate the safety and efficacy of lovastatin in these patients. Twelve kidney graft recipients with stable graft function and a cholesterol (chol) level over 250 mg/dl (6.46 mmol/l) were included. The lipid-lowering treatment consisted of 20 mg lovastatin daily, and all patients received immunosuppression with ciclosporin (CS) and prednisolone. Total chol decreased by 27% (300 ± 56 to 219 ± 28 mg/dl; 7.76 ± 1.45 to 5.66 ± 0.72 mmol/l; p < 0.01), LDL-chol by 35% (220 ± 38 to 143 ± 17 mg/dl; 5.69 ± 0.98 to 3.70 ± 0.44 mmol/l; p < 0.01) and triglycerides by 33% (207 ± 127 to 138 ± 56 mg/dl; 2.36 ± 1.44 to 1.57 ± 0.64 mmol/l; p < 0.05). HDL-chol increased by 10% (57 ± 11 to 63 ± 13 mg/dl; 1.47 ± 0.28 to 1.63 ± 0.34 mmol/l; NS). The ratio of total chol/HDL-chol, a generally accepted risk predictor of atherosclerosis, fell from 5.4 ± 1.3 to 3.3 ± 1.2, p < 0.01. Lipoprotein (a) [lp(a)], an independent risk predictor for atherosclerosis, was also evaluated at baseline and after 6 months of lovastatin treatment and showed a decrease of 39% (32.9 ± 27.6 to 19.9 ± 22.9 mg/dl; 0.85 ± 0.71 to 0.51 ± 0.59 mmol/l; p < 0.05). No adverse side effects were seen at this dosage, and hepatic and renal parameters remained unchanged. In conclusion, our data indicate that 20 mg of lovastatin daily is highly effective in correcting hypercholesterolemia in kidney transplant recipients and is accompanied by a sign