Does the Pretransplant Use of Statins in Recipients Have a Role in the Incidence of Primary Graft Dysfunction after Lung Transplantation? R-ESTAcitos: Multicenter Clinical Study

Abstract

Primary graft dysfunction (PGD) is the main cause of mortality during the first month and the second one within the first year after lung transplant (LT) Statins, 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase inhibitors, have shown to have immunomodulatory and antiinflamatory effects unrelated to their cholesterol-lowering function. We hypothesized that recipient's preoperative statin therapy is associated with decreased incidence of PGD after LT. Multicenter retrospective analysis of all consecutive adult LTs performed in 5 university transplant centers between 2015 and 2017. Combined multiple organ transplantation and lung retransplant recipients were excluded from the analysis. Comparison between groups according to recipient previous use of statins(E+/E-)) was performed. Factors associated with the development of PGD and its severity were analyzed using Chisquare and U-Mann Whitney Test. Logistic regression model was built including those variables with p≤0.1 in the univariate analysis. Significance level p<0.05. A total of 474 adult LT recipients were reviewed, 110 of them (E+=23%) were on statins treatment (SG). LT recipients in the statin group were older (60±7 vs 53±12; p<0.05) and had higher Body Mass Index (BMI) (26.3±3.8 vs 24.8±4.2;p<0.05) than those in not taking statins. The rest of recipient and donor characteristics were similar between groups. A total of 161 patients developed PGD (34%), without significative differences between groups (32.2% vs 39%). However PGD in E+ group was significantly less severe as stated by the percentage of patients with grade 3 PGD at 72h (55.9% vs 37.2%,p<0.036). After propensity score adjustments, only the need for hemoderivates transfusion during the implant (OR 4.50 IC 1.51 - 13.38 p<0.007) remained significant. Recipient statin use was not identified as a protective factor (OR 0.38 CI 0.12 - 1.206, p=0.10). Statin use may contribute to lessen the severity of PGD. Prospective and multicentric studies with larger samples are needed to confirm such results.