SWITZERLAND: Use of Statins in Liver Transplantation

Use of Statins has shown positive effects on chronic liver disorders in recent investigations, in pre-clinical models as well as in clinical studies. However, how statin use by liver transplant patients or donors affects the results of liver transplantation is not known.

Researchers have found in the new study that patients with and without biliary-vascular problems have better survival rates while taking statins after liver transplantation (LT).

Liver Transplantation as a Treatment

The most effective treatment for non-resectable hepatocellular carcinoma and terminal liver disease is liver transplantation. The first year following LT continues to be the most crucial time even though survival rates have steadily increased over time.

The research study has been published in Alimentary Pharmacology and Therapeutics.

The authors of the study proposed that statin use in LT recipients could positively affect the transition to unfavorable outcomes, such as mortality, severe and recurrent biliary-vascular problems, and re-LT. The goal of the study was to investigate the relationship between statin exposure and recipient and graft survival.

Study Methodology

In order to achieve this objective, researchers performed a cohort analysis using data from a national database that included 998 adult patients who had LT from May 2008 to December 2019 and were registered in the Swiss Transplant Cohort Study (STCS) out of which 14% of donors and 19% of recipients were exposed to statins during the study period. They gathered information on the causes, manifestations, comorbidities, use of statins, and duration of exposure to these medications in relation to liver disease. They kept track of demographic information, comorbidities, the type of deceased donor, the cause of death, biochemical parameters, and the usage of statins when it came to donor characteristics.

They investigated the effects of statin use utilizing a multi-state modeling approach, in the first three years following LT. Post-LT death was the main result, with re-LT and/or the emergence of biliary-vascular problems serving as secondary results.

Key Findings of the Study

• As a concomitant covariate in the recipient's model, statin use was linked to lower post-LT mortality (HR = 0.35) and a statistically significant decline in re-LT.
• It wasn't linked to a role in limiting complications (HR = 1.25).
• The use of statins was substantially linked to lower mortality (HR = 0.10) and fewer problems that recurred (HR = 0.43) in patients who developed complications.
• Statin usage was related to a significantly lower risk of acquiring malignancies other than HCC, even though there was no connection between statin use and HCC recurrence (HR = 0.48).

"Our data further strengthen the body of evidence supporting the use of statins in this cohort when there is a therapeutic need by confirming that they are underutilized in LT recipients who qualify for them", added the researchers.

The authors concluded that LT recipients who take statins have a survival benefit and also statins may represent a novel efficient strategy with relevant therapeutic impact in the post-LT environment given their low cost, safety, and widespread use in contrast to the expensive and still restricted current treatments for minimizing graft loss and enhancing life after LT.

Reference

Becchetti C, Dirchwolf M, Schropp J, Magini G, Müllhaupt B, Immer F, Dufour JF, Banz V, Berzigotti A, Bosch J; Swiss Transplant Cohort Study. Use of statins after liver transplantation is associated with improved survival: results of a nationwide study. Aliment Pharmacol Ther. 2022 Aug 18. doi: 10.1111/apt.17192. Epub ahead of print. PMID: 35979872.