Evaluating the Effect of Statins on Prognosis in Patients Undergoing Liver Transplantation for Hepatocellular Carcinoma

Abstract IntroductionThe anti-cancer effect of statins is drawing attention. However, it is unclear whether statin use reduces the risk of hepatocellular carcinoma (HCC) recurrence in patients who undergo liver transplantation (LT) for HCC.MethodsConsecutive patients who underwent LT for HCC between 1995 and 2019 were enrolled. The effect of statins were compared between statin non-user and statin user groups. The primary endpoint was HCC recurrence. All-cause and HCC-related mortality were also evaluated. We also performed multivariable-stratified and sensitivity analyses for HCC recurrence. ResultsA total of 430 patients was enrolled, among whom 323 (75.1%) were statin non-users and 107 (24.9%) were statin users. During a median of 64.9 months (IQR, 26.1–122.6) of follow-up, 79 patients (18.4%) had HCC recurrence and 111 (25.8%) died. Among those who died, 53 (47.7%) were identified as HCC-related mortalities. Statin use was associated with a significantly lower risk of HCC recurrence (adjusted HR = 0.26, 95% CI, 0.11–0.60; P = 0.002) compared to that in statin non-users. Statin users also had significantly lower all-cause and HCC-related mortality than did statin non-users (P < 0.001 & P = 0.040, respectively). There was a dose-dependent relationship between statin use and HCC recurrence. The anti-cancer effect of statins on HCC recurrence was consistently significant across multivariable-stratified and sensitivity analyses. ConclusionsStatin use significantly reduced the risk of HCC recurrence and improved the survival of patients who underwent LT for HCC.