*Purpose: Current guidelines recommend statin use in high risk patients based on the ASCVD (atherosclerotic cardiovascular disease) score, diabetes, or LDL levels. Despite several trials showing safety and potential cardiovascular and liver related benefits, statin use has been limited in liver disease due to theoretical concerns of hepatotoxicity. We aimed to determine the current rate of statin use in patients listed for liver transplant.

*Methods: In a single center retrospective study, we analyzed 164 patients currently listed for liver transplant. Patient variables (demographics, etiology and severity of liver disease, statin use and indication) were collected. Chi-square and Fisher exact tests were used to compare cirrhotics on statins versus those not on statins.

*Results: Out of 164 patients listed for liver transplant, 58% were males, 85% were white, mean age was 58 yrs and mean BMI was 30 kg/m². Alcohol (37%) was the most common etiology of liver disease followed by NASH (23%) and the average MELD-Na was 15 amongst all etiologies. 48% of all patients had indication for statin use, but only 24% were on statins. 42% of those not on statins had an indication for lipid lowering drugs (p=0.0001). Patients who were on statins had significantly higher rates of diabetes (66%, p=0.007), hypertension (76%, p=0.017), and ASCVD >7.5 (43%, p=0.007). There was no difference in MELD scores between patients on statins and not on statins. 76% of NASH patients had an indication for statins but only 23% of them received statins.

*Conclusions: Statin use was avoided in approximately 76% of transplant listed cirrhotic patients who had a strong indication for use, despite no clear history of intolerance or hepatotoxicity, including a significant majority of those with NASH cirrhosis. This reveals a substantial underutilization of safe, effective lipid lowering agents that can prevent cardiovascular mortality and potentially improve or prevent liver related outcomes in transplant candidates. We plan to further follow these patients post transplant to assess long term benefits of statins and harms of statin avoidance, particularly in the subgroup with NASH.

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