S2539 Statin Use After Liver Transplantation Is Associated With Decreased Liver Rejection and Mortality

Introduction: Liver transplantation is a life-saving procedure for patients with end-stage liver disease, but long-term success remains limited by graft failure, acute rejection, and immunologic complications. Statins, beyond their lipid-lowering effects, possess immunomodulatory and anti-inflammatory properties that may influence transplant-related outcomes. However, their safety and efficacy in liver transplant recipients remain underexplored. Methods: We obtained and analyzed retrospective data from the U.S. Collaborative Network on the TriNetX platform and identified patients who underwent liver transplantation. Patients were divided into 2 cohorts: those who initiated statin therapy within 1-year post-transplant (Statin group) and those who did not receive statins within 12 months (Control group). Propensity score matching was performed (1:1) on demographics, comorbidities, MELD-score and immunosuppressive medications. The primary outcomes were liver transplant rejection and liver transplant failure. Secondary outcomes were major adverse cardiovascular events including myocardial infarction (MI) and stroke, biliary stricture, hepatic artery thrombosis, all-cause mortality, liver transplant infection, hepatotoxicity, rhabdomyolysis and myopathy. The risk of each outcome was calculated and expressed as an odds ratio (OR) with a 95% confidence interval (CI). Two-sided P-value < 0.05 was considered statistically significant. Results: After PSM, 1,786 patients using statins were matched to 1,786 non-users. Statin use was associated with a significantly decreased odds of liver rejection (OR 0.55, 95% CI 0.46-0.66, P < 0.0001), liver failure (OR 0.36, 95% CI 0.28-0.46, P < 0.0001), bile duct stricture (OR 0.69, 95% Cl 0.57-0.83, P < 0.0001), all-cause mortality (OR 0.69, 95% CI 0.53-0.90, P = 0.007), liver transplant infection (OR 0.67, 95% Cl 0.50-0.89, P = 0.006) and hepatotoxicity (OR 0.51, 95% Cl 0.39-0.9, P = 0.019). Other outcomes including MI, stroke, hepatic artery thrombosis, rhabdomyolysis and myopathy were statistically similar between the 2 cohorts. Conclusion: Statin use after liver transplantation is associated with improved liver transplantation outcomes including liver rejection, liver failure, liver infection, bile duct stricture and all-cause mortality, without evidence of increased hepatoxtocity or statin-induced rhabdomyolysis or myopathy. These findings support consideration of statins in post-liver transplant settings.