965 Safety of Statins in Decompensated Cirrhosis in Patients Listed for Liver Transplantation

Abstract

INTRODUCTION: Statins (S) are important for cardiovascular disease risk reduction, including in those with cirrhosis (C). S may also slow progression of C, reduce portal pressure, and risk of hepatocellular carcinoma (HCC). A recent AASLD NAFLD practice guidance reiterated recommendations of the National Lipid Association's Statin Liver Safety Task Force (Bays et al, Journal of Clinical Lipidology, 2014), recommending S avoidance in decompensated cirrhosis (DC). In this study, we sought to determine whether S in DC use was associated with a higher risk of adverse outcomes. METHODS: A retrospective case-controlled study examined S use and outcomes in those with DC listed for liver transplant (LT) between January 2000 and December 2017. The S cohort included those who took S for at least 90 days prior to LT (cases). Listed non-S patients (NS) patients served as controls. The primary aim was to determine S safety (side effects, S discontinuation, change in MELD, non-transplant hospitalization, mortality). Secondary outcomes included evidence of possible S benefit (less new or worsening ascites, GI bleed, hepatic encephalopathy, hepatorenal syndrome (HRS), spontaneous bacterial peritonitis (SBP) and hepatocellullar carcinoma (HCC). Univariate and multivariate analysis of demographic data and outcomes were performed using negative binomial and logistic regression with repeated-measured ANOVAs. RESULTS: Eleven hundred ninety-one patients with DC were included. Sixteen percent were taking one of 5 different S (Table 1). There was no apparent serious deleterious effect of continued S use as measured by S discontinuation, progression of MELD score, non-transplant hospitalization, or mortality (Table 2). One developed myalgia not requiring S discontinuation. While S users had moderately higher likelihood of worsening HE, there was a trend for reduction in new HE. Potential S benefit is suggested by lower mortality, hospital admissions, new HCC, ascites, SBP, re-bleeding, and HRS in those taking S. Caution is required in interpreting potential S benefit because of important differences in liver disease distributions and co-morbidities in S and Non S patients. CONCLUSION: Conclusion: In decompensated cirrhosis: 1. Statin use is safe. There is no need to discontinue statins once C advances from compensated to DC; 2. Statins may have a protective effect in suppressing HCC, new or worsening ascites, and other important outcomes. Additional study is needed to better understand if there is an interaction of S and HE.