DDW 2024: Statin Therapy and Improved Waitlist Outcomes in Liver Transplant
Statin therapy shows promising effects across various liver disease stages. In the general population, statin use is associated with a 4% reduced risk of developing new-onset liver disease. A Swedish cohort study revealed that over 12 years, 6.1% of statin users compared to 7.1% of non-users developed severe liver disease, highlighting a potential protective role of statins in disease progression among patients with non-cirrhotic chronic liver disease (CLD). Furthermore, in compensated cirrhosis, statin therapy has been linked to decreased rates of decompensation with a hazard ratio (HR) of 0.55 (95% CI 0.39-0.77) and reduced mortality with an HR of 0.56 (95% CI 0.46-0.69). These findings suggest that statin therapy may confer significant clinical benefits by reducing liver disease severity and complications, thereby potentially improving patient outcomes.
The study evaluated the association between statin therapy and pre-transplant mortality in patients with cirrhosis undergoing liver transplant evaluation, focusing on outcomes stratified by MASH and non-MASH etiologies. A retrospective analysis included 623 patients over three-and-a-half years, of whom 115 were prescribed statins. Statin therapy predominantly consisted of atorvastatin and simvastatin, with doses typically not in the high-intensity range. Patient characteristics associated with statin use included male sex, MASH liver disease, higher body weight, cardiac disease, and diabetes. Despite observed differences in baseline characteristics, including lower MELD sodium and bilirubin levels in statin users, no significant disparity in rates of hepatic decompensation (ascites, hepatic encephalopathy, variceal bleeding) was noted between groups. Notably, while statin therapy did not significantly reduce overall pre-transplant mortality across all patients, a subgroup analysis revealed a statistically significant 16% lower mortality in MASH patients receiving statins compared to those not receiving statins. Conversely, no significant difference was observed in non-MASH patients based on statin exposure.
Statin therapy demonstrated significant benefits in reducing mortality among patients with MASH-related cirrhosis, particularly in subgroups such as those with coronary artery disease (CAD) and those without diabetes mellitus (DM). Specifically, within the MASH cohort, statin use was associated with a notable decrease in mortality rates among patients with CAD (23% without statin vs. 6% with statin, p=0.025) and those without DM (21% without statin vs. 6% with statin, p=0.038). However, no significant differences in post-transplant survival were observed between statin and non-statin groups or between MASH and non-MASH cirrhosis patients. These findings underscore the potential of statin therapy to mitigate pre-transplant mortality in MASH-related cirrhosis, albeit within the study's limitations due to its retrospective nature and inability to capture interruptions in statin therapy. In conclusion, statin therapy appears beneficial for reducing mortality in MASH cirrhosis patients, particularly those with CAD or without diabetes.
Digestive Disease Week (DDW) 2024, May 18-21, 2024, Washington, D.C.
