Uncertain benefit of statins in pediatric heart transplant recipients: A PHTS analysis

Abstract

PurposeCardiac allograft vasculopathy (CAV) is a leading cause of graft failure in pediatric heart transplant recipients (HTRs). Early statin use has been shown to reduce CAV incidence and all-cause mortality in adult HTRs. We sought to evaluate the contemporary prevalence and trends of statin use in pediatric HTRs and the association between statin use with CAV development and graft failure. MethodsPatients <17 years of age at time of primary heart transplant who survived to ≥3 years without CAV were identified from the Pediatric Heart Transplant Society database (2001-2018). Statin use in the first 3 years post-transplant was defined as consecutive, intermediate, or absent. Kaplan Meier survival, multivariable modeling and propensity score-matched analyses evaluated associations between statin use and CAV incidence and graft survival, with sub-analyses performed on subjects age ≥10 at transplant. ResultsAmong 3485 (1086 age ≥10) HTRs, 584 (17%) received consecutive statin therapy, 647 (19%) intermediate use, and 2254 (65%) no statin. Statin use varied widely between sites, with increasing use in the ≥10-year-old cohort over time. By multivariate analysis, statin use was not associated with graft loss. Consecutive statin use was also not associated with graft survival or freedom from CAV development when compared to absent statin use in unmatched or propensity-matched analyses. ConclusionWhile statins remain commonly utilized in pediatric HTRs, early consecutive statin therapy did not decrease CAV incidence or graft loss. The differing effects of statins on CAV development and progression in pediatric vs. adult HTRs suggest differing risk and mediating factors and requires further study.