Statin Use Is Associated with Improved Function and Survival of Lung Allografts

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Abstract
3-Hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (stat- cantly decreased incidences of mild-to-severe acute allograft ins) are widely used antilipidemic agents that are also immuno- rejection and obliterative bronchiolitis (OB), along with im- modulatory. We evaluated possible effects of these agents after proved pulmonary function, compared with the control sub- lung transplantation by comparing outcomes of 39 allograft recipi- jects. Overall, maintenance calcineurin inhibitor levels were ents, who were prescribed statins for hyperlipidemia, with those lower in the LT-statin group, and these recipients also received of 161 contemporaneous control recipients who did not receive fewer courses of augmented immunosuppression. Most im- these drugs. Acute rejection ( Grade II) was less frequently found portantly, the survival of LT-statin group members was much in the statin group (15.1 versus 25.6% of biopsies, p 0.01). None greater than that of untreated recipients. Conversely, toxici- of 15 recipients started on statins during postoperative Year 1 devel- ties attributable to statins were largely limited to mild and oped obliterative bronchiolitis, whereas the cumulative incidence reversible symptoms. These data suggest that statins may of this complication among control subjects was 37% (p 0.01). have favorable effects in lung transplant recipients. Total cellularity, as well as proportions of inflammatory neutrophils and lymphocytes, were significantly lower in bronchoalveolar la- METHODS vages of statin recipients. Among double lung recipients, those taking statins had significantly better spirometry: FVC (80 2 versus The study group consisted of 200 consecutive patients who survived 70 1%) and FEV1 (87 2 versus 70 1%), as percentages of more than 30 days after pulmonary transplantation between January predicted values, and absolute FEV1/FVC (83.4 1.2 versus 78.6 1995 and December 2000. To avoid introductions of biases that could 0.5) (all p 0.01). The 6-year survival of recipients taking statins inadvertently occur by conscious (or subliminal) differences in surveil- (91%) was much greater than that of control subjects (54%) (p lance or treatments of these groups, the observation period ended 0.01). These data suggest statin use may have substantial clinical July 2001, at the time this project was conceptualized and initiated. benefits after pulmonary transplantation. Pretransplantation evaluations routinely included coronary angiogra- phy for males more than 50 years old and for females more than 55