Use of statins after liver transplantation is associated with improved survival: results of a nationwide study

Abstract

Summary Background There is limited information on the effects of statins on the outcomes of liver transplantation (LT), regarding either their use by LT recipients or donors. Aim To analyse the association between statin exposure and recipient and graft survival. Methods We included adult LT recipients with deceased donors in a nationwide prospective database study. Using a multistate modelling approach, we examined the effect of statins on the transition hazard between LT, biliary and vascular complications and death, allowing for recurring events. The observation time was 3 years. Results We included 998 (696 male, 70%, mean age 54.46 ± 11.14 years) LT recipients. 14% of donors and 19% of recipients were exposed to statins during the study period. During follow‐up, 141 patients died; there were 40 re‐LT and 363 complications, with 66 patients having two or more complications. Treatment with statins in the recipient was modelled as a concurrent covariate and associated with lower mortality after LT (HR = 0.35; 95% CI 0.12–0.98; p = 0.047), as well as a significant reduction of re‐LT (p = 0.004). However, it was not associated with lower incidence of complications (HR = 1.25; 95% CI = 0.85–1.83; p = 0.266). Moreover, in patients developing complications, statin use was significantly associated with decreased mortality (HR = 0.10; 95% CI = 0.01–0.81; p = 0.030), and reduced recurrence of complications (HR = 0.43; 95% CI = 0.20–0.93; p = 0.032). Conclusions Statin use by LT recipients may confer a survival advantage. Statin administration should be encouraged in LT recipients when clinically indicated.

Letter: PCSK9 inhibitor for liver transplant patients during the post‐statin era?

“…

In a nationwide prospective database study, Becchetti et al explored the potential association of statin use after liver transplantation (LT), and found a survival advantage among LT recipients receiving statin therapy. 1 Despite the potential benefits, the authors noticed the underuse of statins in LT recipients; similar trends were also found in other studies. This might be attributed to concerns about the complex interactions between immunosuppressive agents and statins.

…”

Letter: what explains improved survival from statin exposure after liver transplantation?

“…We read with great interest the recent article by Becchetti et al 1 examining the association between statin exposure and survival following liver transplantation (LT). Through a nationwide databasebased cohort study, the authors found that statin use by LT recipients was associated with improved survival.…”

“…Data sharing not applicable to this article as no datasets were generated or analysed during the current study. Yi-Zhou Jiang 1,2,3 Li-Ying Sun 1,2,3 Zhi-Jun Zhu…”

Letter: PCSK9 inhibitor for liver transplant patients during the post‐statin era? Authors' reply

“…We thank Dr. Wang et al for their interest in our paper. 1,2 They suggested that pro-protein convertase subtilisin/kexin type 9 (PCSK9) inhibitors could be a promising option for the treatment of dyslipidaemia in liver transplant (LT) recipients since they may be better tolerated. Serious adverse drug reactions, unstable immunosuppression level and immunological reactions have been reported only rarely with PCSK9 inhibitors, supporting that they may have an acceptable safety profile in solid organ transplant (SOT) recipients.…”