Graft Vessel Disease Following Heart Transplantation: A Systematic Review of the Role of Statin Therapy

• Published in: World journal of surgery 2014-09, Vol.38 (9), p.2324-2334
• Main Authors: Som, Robin, Morris, Peter J., Knight, Simon R.
• Format: Article
• Language: English
• Subjects: Abdominal Surgery; Atorvastatin; Cardiac Surgery; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - etiology; Coronary Artery Disease - prevention & control; General Surgery; Graft Rejection - chemically induced; Graft vs Host Reaction; Heart Transplantation - adverse effects; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - adverse effects; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Hyperlipidemias - drug therapy; Hyperlipidemias - etiology; Lovastatin; Medicine; Medicine & Public Health; Pravastatin; Radiography; Randomized Controlled Trials as Topic; Simvastatin; Statin; Surgery; Survival Rate; Thoracic Surgery; Ultrasonography; Vascular Surgery
• ISSN: 0364-2313; 1432-2323
• DOI: 10.1007/s00268-014-2543-x

Background Graft vessel disease (GVD) is a significant cause of morbidity and mortality in cardiac allograft recipients. Hyperlipidemia is a risk factor for GVD, and the majority of patients will display abnormal lipid profiles in the years following transplant. Objective This systematic review aims to establish the clinical impact of statins in cardiac allograft recipients, critically appraising the literature on this subject. Methods A literature search for randomized studies assessing statin use in cardiac allograft recipients was undertaken. The Cochrane Central Registry of Controlled Trials, MEDLINE, EMBASE, clinicaltrials.gov, and the Transplant Library from the Centre for Evidence in Transplantation were searched. The primary outcome was presence of GVD. Secondary outcomes included graft and patient survival, acute rejection, and adverse events. Meta-analysis was precluded by heterogeneity in outcome reporting and therefore narrative synthesis was undertaken. Results Seven randomized controlled trials (RCTs) were identified. The majority of RCTs demonstrated some risk of bias, and methods of outcome measurement were variable. Studies reporting incidence or severity of GVD suggest that statins do confer benefit. Survival benefit from statin use is modest. There is a low incidence of adverse events attributable to statins. There was no difference in the overall number of episodes of rejection. Conclusion Whilst the methodological quality of evidence describing the use of statins in cardiac allograft recipients is limited, the available evidence suggests benefit from their use. This is compatible with the effects of statins in non-transplant patients with cardiovascular disease. Furthermore, the rate of adverse events in the trials is low.