Ten-Year Follow-Up of a Randomized Trial of Pravastatin in Heart Transplant Patients

Kobashigawa, Jon A.; Moriguchi, J.; Laks, Hillel; Wener, Liane; Hage, A.; Hamilton, Michèle A.; Cogert, G.; Márquez, A.; Vassilakis, Maria Espejo; Patel, Jignesh; Yeatman, Lawrence A.

doi:10.1016/j.healun.2005.02.009

Cited by 162 publications

(100 citation statements)

References 20 publications

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“…Clinical trials were included in the meta-analysis if the following criteria were met: (1) studies that reported any of the following clinical outcomes in both treatment arms: mortality, hemodynamically significant or fatal rejection, coronary vasculopathy, terminal malignancy, and myopathy; (2) minimum follow-up period of at least 1 year; and (3) studies involving predominantly adult subjects (age >18 years). Case reports, editorials, case series, and review articles were not included.…”

Section: Study Selectionmentioning

confidence: 99%

Impact of Statin Use After Heart Transplantation

Vallakati

Reddy

Dunlap

et al. 2016

Circ: Heart Failure

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Background— Although various studies revealed the beneficial effects of statins in post–cardiac transplant patients, these were relatively small and low-powered studies. We performed a meta-analysis of published studies to evaluate the role of statins in post–cardiac transplant patients, specifically examining the effects on hemodynamically significant/fatal graft rejection, coronary vasculopathy, terminal cancer, and overall survival. Methods and Results— We searched PubMed, Cochran CENTRAL, and Web of Science databases using the search terms “cardiac transplant” or “heart transplant,” and “statin” for a literature search. A random-effects model with Mantel–Haenszel method was used to pool the data. We identified 10 studies, 4 randomized controlled trials, and 6 nonrandomized studies, which compared outcomes in heart transplant recipients undergoing statin therapy to statin-naive patients. A pooled analysis of 9 studies reporting mortality revealed that the use of statins was associated with significant reduction in all-cause mortality (odds ratio, 0.26; 95% confidence interval, 0.20–0.35; P <0.0001). Statins also decreased the odds of hemodynamically significant/fatal rejection (odds ratio, 0.37; 95% confidence interval, 0.21–0.65; P =0.0005), incidence of coronary vasculopathy (odds ratio, 0.33; 95% confidence interval, 0.16–0.68; P =0.003), and terminal cancer (odds ratio, 0.30; 95% confidence interval, 0.15–0.63; P =0.002). Conclusions— The evidence from a pooled analysis suggests that statins improve survival in heart transplant recipients. Statins may prevent fatal rejection episodes, decrease terminal cancer risk, and reduce the incidence of coronary vasculopathy. Additional prospective studies are needed to further investigate and explain this association.

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Section: Study Selectionmentioning

confidence: 99%

Impact of Statin Use After Heart Transplantation

Vallakati

Reddy

Dunlap

et al. 2016

Circ: Heart Failure

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“…Statin therapy (specifically pravastatin and simvastatin) from the time of transplantation also decreases allograft vasculopathy (24,25). Thus, modifications to the medication regimen at the time of transplantation may decrease the future need for retransplantation for cardiac allograft vasculopathy.…”

Section: Alternatives To Retransplantationmentioning

confidence: 99%

Heart Retransplantation

Johnson

Aaronson

Canter

et al. 2007

American Journal of Transplantation

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Retransplants comprise only a small minority (3-4%) of heart transplants, however outcome following retransplantation is compromised. Risk factors for a poor outcome following retransplantation include retransplantation early (<6 months) after primary transplant, retransplantation for acute rejection or early allograft failure, and retransplantation in an earlier era. The incidence of rejection and infection is similar following primary transplant and retransplantation. The compromised outcomes and risk factors for a poor outcome are similar in adult and pediatric heart retransplantation. However, due to the short half-life of the transplanted heart, it is an expectation that patients transplanted in childhood may require retransplantation. Based on the data available and the opinion of the working group, indications for heart retransplantation are (i) chronic severe cardiac allograft vasculopathy with symptoms of ischemia or heart failure (should be considered) or asymptomatic moderate or severe left ventricular dysfunction (may be considered) or (ii) chronic graft dysfunction with symptoms of progressive heart failure in the absence of active rejection. Patients with graft failure due to acute rejection with hemodynamic compromise, especially <6 months post-transplant, are inappropriate candidates for retransplantation. In addition, guidelines established for primary transplant candidacy should be strictly followed.

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“…Use of statins is encouraged because of a substantial survival benefit and significantly lower incidence of CAV (184,185). In addition, mTOR inhibitors reduce neointimal thickening in animal models and in human transplantation (186)(187)(188).…”

Section: R E V I E W S E R I E S : T R a N S P L A N Tat I O Nmentioning

confidence: 99%