Department of Anesthesiology Mayo Clinic Arizona Phoenix AZ.
Liver Transpl. 2021 Oct;27(10):1432-1442. doi: 10.1002/lt.26093. Epub 2021 Jun 30.
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. We reviewed all primary orthotopic liver transplantation (OLT) records from January 2014 to December 2019 from our center. Intraoperative deaths were excluded. Recipient, 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 (HACs), graft failure, and death, accounting for clinical covariates and competing risks. A total of 672 OLT recipients were included in the analysis. Of this cohort, 11.9% (n = 80) received statin therapy. A total of 47 patients (7.0%) had VTE events. HACs occurred in 40 patients (6.0%). A total of 42 (6.1%) patients experienced graft loss, whereas 9.1% (n = 61) of the cohort died during the study interval. Eighty OLT recipients (29.8%) were treated with statins. In the statin treated group, 0% of patients had VTE versus 7.9% of those not on statins (P = 0.02). HACs were identified in 1.2% of the statin group and 6.8% of the nonstatin group. Untreated hyperlipidemia was associated with a 2.1-fold higher risk of HACs versus patients with no hyperlipidemia status (P = 0.05). Statin therapy was associated with significantly better risk-adjusted thromboembolic event-free survival (absence of VTE, cerebrovascular accident, myocardial infarction, HACs, and death); hazard ratio, 2.7; P = 0.01. These data indicate that statin therapy is correlated with a lower rate of VTE and HACs after liver transplantation.
他汀类药物治疗可能降低静脉血栓栓塞症（VTE）的风险，而静脉血栓栓塞症可能会影响实体器官移植的结果。我们采用回顾性队列研究的方法，评估了根据高血脂状态和他汀类药物使用分层的肝移植后 VTE 及其他并发症的发生率。我们回顾了 2014 年 1 月至 2019 年 12 月期间我院所有原发性原位肝移植（OLT）的记录。排除术中死亡病例。收集受者、供者临床和人口统计学数据。我们开发了风险调整模型，以评估他汀类药物使用对 VTE、肝动脉并发症（HACs）、移植物衰竭和死亡发生的影响，同时考虑了临床协变量和竞争风险。共有 672 名 OLT 受者纳入分析。在这一队列中，11.9%（n=80）接受了他汀类药物治疗。共有 47 例患者（7.0%）发生了 VTE 事件。40 例患者发生了 HACs（6.0%）。共有 42 例（6.1%）患者发生了移植物失功，而在研究期间，9.1%（n=61）的患者死亡。80 名 OLT 受者（29.8%）接受了他汀类药物治疗。在接受他汀类药物治疗的组中，0%的患者发生 VTE，而未接受他汀类药物治疗的患者中有 7.9%发生 VTE（P=0.02）。他汀类药物组中有 1.2%的患者发生 HACs，而未接受他汀类药物治疗的患者中有 6.8%发生 HACs。与无高血脂状态的患者相比，未经治疗的高血脂症患者发生 HACs 的风险增加 2.1 倍（P=0.05）。他汀类药物治疗与血栓栓塞事件无复发的风险调整生存时间显著改善相关（无 VTE、脑血管意外、心肌梗死、HACs 和死亡）；风险比为 2.7；P=0.01。这些数据表明，他汀类药物治疗与肝移植后 VTE 和 HACs 的发生率较低相关。
