Metaanalysis of statins and survival in de novo cardiac transplantation

The use of HMG CoA reductase inhibitors (statins) after cardiac transplantation has been suggested to decrease the incidence of severe rejection and improve survival. Individual investigations that have led to this suggestion are randomized (but not placebo-controlled) studies, including small patient numbers that have (and thus underpowered) and enrolling heterogeneous subjects (including retransplant recipients). The purpose of this pooled analysis was to quantify the benefit of statins on survival in de novo cardiac transplant recipients.

Medline (1966 to 2003) was queried using the keywords statin, HMG CoA reductase inhibitors, cardiac transplantation, transplant, cholesterol, atorvastatin, fluvastatin, lovastatin, pravastatin, and simvastatin. In addition, we searched the cited literature and previously published systematic reviews. Of 36 articles retrieved, 3 randomized controlled studies met our population inclusion criteria; namely age >18 years, de novo heart transplant recipients, statin therapy within 3 months, and > or = 1-year follow-up. Pooled data were metaanalyzed by Mantel-Haenszel tests using a random effects model that included tests for heterogeneity.

The three pooled studies included 246 patients (statin, n = 129; no statin, n = 117) and 27 events (11%). The pooled analysis demonstrated a significant reduction in mortality with statin use (RR 0.31; 95% CI 0.13 to 0.7; P = .006) without significant heterogeneity (P = .7) among the studies. Two of the three studies reported allograft rejection with hemodynamic compromise. The pooled analysis demonstrated a significant benefit on this endpoint (RR 0.22, 95% CI 0.08 to 0.63; P = .004).

This meta-analysis demonstrates that statin therapy decreases rejection episodes with hemodynamic consequences and improves 1-year heart transplant survival.