HMG-COA REDUCTASE INHIBITORS SIGNIFICANTLY IMPROVE SURVIVAL IN CLINICAL LUNG TRANSPLANTATION, A RETROSPECTIVE ANALYSIS OF MORE THAN 500 PATIENTS

Abstract

P647 Aims: 3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (statins) are known as effective lipid-lowering agents. Recently, increased survival times were demonstrated after transplantation (heart, kidney, liver) in patients, receiving statins and there is data suggesting a lipid lowering independent effect, as statins act as direct inhibitors of induction of MHC class-II expression and thus as indirect repressors of T-cell activation. We evaluated the effects of statins after lung transplantation through a retrospective analysis of 500 lung-allograft recipients, of whom77 received statins for excessive serum lipid levels. Methods: We performed a retrospective analysis of 502 recipients after lung transplantation (1988-2003). In order to allow for comparability of the patients receiving statins with those who did not, patients who died before the post operative day of first statin administration were excluded (n=77). 3 Patients had to be excluded from the statin group, due to missing clinical data. Statistical analysis included survival, as well as lung function analyses. BOS was defined by loss of FEV1, with BOS 0 = 80-100% of best FEV1, BOS 1 = 65-80% of best FEV1, BOS 2 = 50-65% of best FEV1 and BOS 3 = <50% of best FEV1. Results: Out of 502 patients undergoing lung transplantation between 1988 and 2003, 77 received pravastatin, 2 received lovastatin and 6 simvastatin for treatment of elevated serum lipid levels. Comparison of the two cohorts showed a significant increase in survival in the statin group (2435.31±1260.51 day vs.1595.10±1338.50 day, P<0.0001). Also, lung function was preserved at a significantly higher level in the group receiving statins (FVCBEST: 3809±1094.63ml vs 3509±1170.36ml, P<0.05; FEV1BEST: 2975±967.99ml vs 2695±1014.18ml, P<0.05). Conclusions: Pravastatin significantly improves long-term survival after lung transplantation in a retrospective analysis. Thus, we have added pravastatin to our standard immunosuppressive regimen. As the underlying mechanism is still unclear, we have initiated animal experiments to further analyze this question.