Short-term effects of statin therapy in patients with hyperlipoproteinemia after liver transplantation: results of a randomized cross-over trial

Background/Aims: Hyperlipoproteinemia is frequent following liver transplantation and may lead to atherosclerosis. Lipid-lowering agents may be useful, but could interfere with the function of the transplanted organ and with immunosuppression. We therefore evaluated in a prospective, randomized, open-labeled cross-over trial the effect of two frequently used 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors (pravastatin 10 mg d−1 and cerivastatin 0.1 mg d−1) in hyperlipoproteinemic patients after liver transplantation. Methods: Sixteen patients (6.3±2.0 years post-transplantation, cyclosporine n=11, tacrolimus n=5) with hyperlipoproteinemia (cholesterol 246±42, triglycerides 191±87, low-density lipoprotein (LDL)-cholesterol 161±35, high-density lipoprotein (HDL)-cholesterol 44±11 mg dl−1) were included. Treatment periods of 6 weeks were separated by a 4-week washout period. Results: Both medications were tolerated well, no effects on serum concentrations of liver enzymes or immunosuppressive agents were observed. Cerivastatin and pravastatin decreased (P<0.001) cholesterol by 21±10% and 15±10%, LDL-cholesterol by 27±14% and 17±15%, respectively, while triglyceride and HDL-cholesterol concentrations did not change significantly. LDL/HDL-cholesterol markedly improved (P<0.001) by 29±16% (cerivastatin) and 16±16% (pravastatin). Cerivastatin was more potent than pravastatin in patients receiving cyclosporine A, while there was no significant difference in patients receiving tacrolimus. Conclusions: Low-dose cerivastatin and pravastatin significantly improve lipid profiles following liver transplantation without affecting liver function or immunosuppression.