Statins in liver transplant recipients: Rates of use, mortality and rejection.
Selim R, Abdulhamid A, Shyamraj A, Watson A, Tang J, and Jafri SM. Statins in liver transplant recipients: Rates of use, mortality and rejection. Am J Transplant 2017; 17:585.
Am J Transplant
Introduction: Liver transplant recipients are prone to developing metabolic syndrome following transplant, likely secondary to immunosuppressant use. Among those with metabolic syndrome, the rate of cardiovascular events was found to be high. Statin therapy in liver transplant recipients has been shown in prior studies to modify cardiovascular risk without increased risk of adverse events. In this study, we evaluated the quality of lipid therapy in patients with diabetes and cardiac disease following their liver transplant. In addition, we determined whether the use of statins is associated with any difference in rejection or mortality. Methods: Our population of study included 1000 liver transplant patients at a large tertiary center. This included 651 males and 349 females. Age of patients ranged from 26-86 (mean:63). We determined at 6, 12, and 24 months (± 2 months) post-transplant the percentage of those age 40-75 with diabetes and coronary artery disease (CAD) on statins. In addition, we compared the rejection and mortality rates for each group. Results: 46 patients were between 40-75 years old and had both CAD and diabetes. Within that set of patients, 44 had a known 6-month and 12-month statin status, and 45 had a known 2-year statin status. Statin was given at 6 months to 7 of 44 patients (15.9%), at 12 months to 7 of 44 patients (15.9%), and at 2 years to 14 of 45 patients (31.1%). The mortality rate was 0.0% versus 10.8%, 0.0% versus 8.1%, and 0% versus 12.9%, at 6, 12, and 24 months for patients with versus without statin, respectively. The rejection rate was 14.3% versus 13.5%, 14.3% versus 13.5%, and 14.3% versus 12.9% at 6, 12, and 24 months for the patients with versus without statin, respectively. Conclusion: Our results demonstrate that we are under-utilizing statin therapy where indicated in our liver transplant population. We also demonstrate an associated reduction in mortality with little difference in rejection rates with the use of statins. Given the established cardiovascular benefit without increased risk of adverse events associated with use of statins, we recommend screening transplant patients soon after their transplants for development of risk factors or comorbidities that would qualify for statin initiation and appropriately begin therapy.