Statin Therapy and the Incidence of Thromboembolism and Vascular Events Following Liver Transplantation

Statin therapy may reduce the risk of venous thromboembolism (VTE), which may impact solid organ transplant outcomes. We evaluated the incidence of VTE and other complications after liver transplantation stratified by hyperlipidemia status and statin use using a retrospective cohort study approach from a high-volume liver transplant center. We reviewed all primary orthotopic liver transplant (OLT) records from January 2014-December 2019 from our center. Intraoperative deaths were excluded. Recipient and donor clinical and demographic data were collected. We developed risk-adjusted models to assess the effect of statin use on the occurrence of VTE, hepatic artery complications, graft failure, and death, accounting for clinical covariates and competing risks. 672 OLT recipients were included in the analysis. 11.9% (n=80) of this cohort received statin therapy. 47 patients (7.0%) had VTE events. Hepatic artery complications occurred in 40 patients (6.0%). 42 (6.1%) patients experienced graft loss while 9.1% (n=61) of the cohort died during the study interval. 268 (39.9%) OLT recipients had hyperlipidemia, of which 80 (29.8%) were treated with statins. Of those treated with statins, 0% of patients had VTE vs. 7.9% of those not on statins (p=0.01). Hepatic artery complications were identified in 1.2% of the statin group and 6.8% of the non-statin group. Untreated hyperlipidemia was associated with a 2.1-fold higher risk of hepatic artery complications vs no hyperlipidemia status patients (p=0.05). Statins were associated with significantly better risk-adjusted thromboembolic event-free survival (absence of DVT, PE, CVA, MI, HAC, and death) (90% statins vs. 73.9% untreated; HR =0.37, p = 0.01). These data indicate that statin therapy is correlated with a lower rate of VTE and hepatic artery complications after liver transplantation. Prospective studies are warranted.