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. 2022 Oct;56(7):1194-1204.
doi: 10.1111/apt.17192. Epub 2022 Aug 18.

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

Chiara Becchetti  1 , Melisa Dirchwolf  1   2 , Jonas Schropp  1 , Giulia Magini  3 , Beat Müllhaupt  4 , Franz Immer  5 , Jean-François Dufour  1   6 , Vanessa Banz  1 , Annalisa Berzigotti  1 , Jaume Bosch  1 ; Swiss Transplant Cohort Study
Collaborators, Affiliations

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

Chiara Becchetti et al. Aliment Pharmacol Ther. 2022 Oct.

Abstract

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.

Keywords: cardiovascular disease; dyslipidemia; solid organ transplantation; survival.

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Conflict of interest statement

None.

Figures

FIGURE 1
FIGURE 1
Graphical representation of the possible transitions. The numbers in the arrows indicate the observed transitions. The number of transitions from biliary‐vascular complications to re‐LT and death is given globally, including those coming from first or recurrent biliary‐vascular complications.
FIGURE 2
FIGURE 2
Cumulative transition hazards with significant effects of recipient statin use: Transplant to transplant; transplant to death; biliary‐vascular complication to biliary‐vascular complication; and biliary‐vascular complication to death.
FIGURE 3
FIGURE 3
Different causes of death among recipients expose or not to statins.
See this image and copyright information in PMC

Comment in

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