*Purpose: Cardiovascular disease (CVD) remains a major cause of long-term mortality in liver transplant recipients (LTR). Adequate control of CVD risk factors like hypertension, diabetes, and dyslipidemia is therefore essential in this population. Although there is robust data supporting aggressive use of statin therapy in patients with documented CVD or dyslipidemia in general population, there is currently no data regarding post-liver transplantation (LT) CVD management or adherence to societal guidelines for management of dyslipidemia.

*Methods: Patients undergoing at liver transplantation at Virginia Commonwealth University from January 2007 to January 2017 were reviewed. All LTR had a thorough evaluation for coronary artery disease (CAD) prior to listing. Patients were considered eligible to be prescribed a statin if they had documented CAD on angiography or dyslipidemia (total cholesterol ≥200 mg/dL or low-density lipoprotein cholesterol ≥100 mg/dL). The primary endpoint consisted of percentage of eligible LTR receiving statins. Secondary endpoints were[VARR1] adverse events from statin use and patient survival. Associated factors to statin use and mortality were assessed using a logistic regression and Cox proportional hazards models, respectively.

*Results: The mean age of the 495 LTR patients in the sample was 55.3 ±9.3 years. The median follow-up period was 4.5 years (range:0-11 years). In the post-LT period, 245 patients were eligible for statin therapy, and statin use was noted in 106 (43%) eligible patients. CAD was noted in 129 (26.1%) patients during the pre-LT evaluation, and 45% of these were on statin therapy post-LT. In the post-LT period 116 patients had dyslipidemia requiring statin therapy and 53% of them were on statin therapy. In patients with documented CAD prior to LT, 16 (12.4%) had statin at LT, the median time to initiation of statin therapy was for those statin-free at LT was 18 months. Factors associated with post-LT statin use included gender, CAD, diabetes (DM) and hypertension (HTN) (Table 1). Lower levels of alanine transaminase (ALT), aspartate transaminase (AST) and total bilirubin were observed in patients using statins (Table 2). Finally, no patients developed liver failure or acute liver injury from statin use. Statin was related to longer survival time [HR:0.20, 95%CI:0.11, 0.38]

*Conclusions: The statin therapy is underutilized in LTR. The use of statin therapy after LT did not cause significant elevations in liver enzymes. There was no increased in hepatic complications with statin use. There was survival benefit noted with statin use. Further studies are needed to clarify the role of statins in this population.

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