Low Statin Use Post-liver Transplant Despite Increased Rates of Dyslipidemia

Previous literature has demonstrated that hyperlipidemia is common post-transplant; however, low statin utilization has been seen post-liver transplant. Furthermore, assessment of statin qualification in this setting is limited. This study's objective was to evaluate the incidence of hyperlipidemia and determine the rate of qualification for and initiation of statin therapy in liver transplant recipients to better characterize the complication and associated clinical practice behaviors. This single center, retrospective cohort study included adult patients who received an isolated liver transplant between January 1, 2015 and June 30, 2019 and had lipid panels within 15 months pre- and post-transplant. The dual primary outcomes were the incidences of hyperlipidemia and statin qualification, as determined by 2012 AASLD and 2018 ACC/AHA guidance. Secondary outcomes included statin use and tolerability, hypertriglyceridemia, and immunosuppression factors. Of the 282 patients screened, 79 patients were included. Compared to pre-transplant, incidences of hyperlipidemia and statin qualification were both increased post-transplant (hyperlipidemia: 21.5% vs 49.4%, P = 0.0003; statin qualification: 46.8% vs 64.6%, P = 0.025). Of the 51 statin-qualifying patients post-transplant, twenty-two (43%) received statin therapy. One patient experienced muscle aches requiring statin discontinuation. Hypertriglyceridemia was more common post-transplant than pre-transplant (11.4% vs 60.8%, P < 0.0001). Of patients on tacrolimus, 58% qualified for statin therapy compared to 93% of patients on an mTOR inhibitor. Nearly two-thirds of liver transplant recipients qualify for statin therapy post-transplant. Despite increased rates of dyslipidemia and statin qualification post-liver transplant, statin therapy remains underutilized. Optimization of lipid management remains an area of need post-liver transplant.