Statin benefits after pediatric heart transplant uncertain
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Key takeaways:
- Statin use after pediatric heart transplant does not improve outcomes.
- Statin use after transplant varied widely across centers.
Data from a large pediatric heart transplant recipient database suggest initiating statin therapy after transplant has no benefit on graft survival or freedom from cardiac allograft vasculopathy compared with no statin use.
The International Society for Heart and Lung Transplantation guideline for the care of heart transplant recipients recommends considering statin therapy for both pediatric and adult heart transplant recipients, and decades of safety and effectiveness data also support statin use in children, Madeleine Townsend, MD, a clinical fellow at Cleveland Clinic Children’s Hospital, and colleagues wrote in the study background.
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“Despite this, evidence supporting statin use in pediatric heart transplant recipients has been limited to observational, largely single-center experiences, with mixed results to date,” the researchers wrote. “A previous Pediatric Heart Transplant Society (PHTS) analysis found no association between statin use in the first-year posttransplant and posttransplant survival or cardiac allograft vasculopathy development and in fact raised concern for risk of earlier rejection.”
Townsend and colleagues analyzed data from 3,485 children and adolescents who underwent heart transplant and survived to 3 years or longer without cardiac allograft vasculopathy, identified from the PHTS database (2001-2018), an international database spanning 54 centers across five countries. Researchers defined statin during the 3-year period after transplant as consecutive (statin use present on all annual follow-up forms), intermediate (present on 1-2 annual follow-up forms), or none (no documented use in the first 3 years), and evaluated the associations between statin use, cardiac allograft vasculopathy and graft survival. Researchers also conducted subanalyses for children aged 10 years or younger at the time of transplant (n = 1,086).
The findings were published in The Journal of Heart and Lung Transplantation.
Within the cohort, 17% of children received consecutive statin therapy, 19% received intermediate use and 65% received no statin therapy. Among patients aged 10 years and younger at the time of transplant, 29% received consecutive statin therapy, 32% received intermediate statin use and 39% did not receive statin therapy. There was increasing statin use for children aged 10 years or older over time.
Data show that statin use varied widely between sites, ranging from 0% to 25% of patients for 20 sites, 25% to 50% for 23 sites and 50% to 75% for eight sites.
Statin use was not associated with graft loss; however, consecutive statin use was also not associated with graft survival or freedom from cardiac allograft vasculopathy development compared with no statin use in unmatched and propensity-matched analyses.
“We examined the effect of practice variation by performing a secondary analysis comparing patients aged 10 years at transplant at low statin use centers to those receiving care at high statin use centers,” the researchers wrote. “There were no differences in time to graft loss or cardiac allograft vasculopathy diagnosis between patients not on statins at low statin use centers compared to those on statins at high statin use centers.”
The researchers noted that the data reflect a “lack of consensus” on the benefit of statin therapy for pediatric heart transplant recipients.
“While statins remain commonly utilized in older pediatric heart transplant recipients, early consecutive statin therapy did not decrease the development of cardiac allograft vasculopathy or graft loss in pediatric heart transplant recipients,” the researchers wrote. “The differing effects of statins on cardiac allograft vasculopathy development and progression in pediatric vs. adult heart transplant recipients suggest differing risk and mediating factors. This is an important area that requires further study, as we continue to seek out preventive strategies that slow or prevent graft loss and optimize long-term outcomes in pediatric heart transplant recipients.”
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