Metabolic syndrome and solitary pancreas transplantation: role for statin therapy

J. Scalea, R. Barth, S. Fayek, J. Bromberg, B. Philosophe, S. T. Bartlett, M. Cooper
University of Maryland, Surgery, Div. of Transplantation, Baltimore, USA

Introduction: Statin use following renal allotransplantation improves long-term outcome and reduces the incidence of glomerulonephritis. Additionally, statin use decreases the incidence of the metabolic syndrome commonly seen in diabetic patients. With both an anti-inflammatory and cardio-protective effect, statins may also improve outcomes in pancreas transplantation.

Methods: A retrospective review at a single institution was undertaken. Patients that underwent solitary pancreas transplantation were identified. Multiple data points including recipient and donor demographics, patient and graft outcomes, and early use of statins were collected. Statistical analysis was performed using the student’s T-test.

Results: Sixty-eight (68) patients underwent solitary pancreas transplantation within the study period. 54% were female, mean recipient age was 41.6 years, and mean donor age was 24.2 years. Thirty-three (33) patients underwent PAK versus PTA. Eighteen patients (26%) were already on, or were prescribed, a statin at the time of hospital discharge; of these 9 received atorvastatin, 7 received simvastatin, and 2 received pravastatin. Mean BMI for those on a statin was 29.4 kg/m² vs 25.1 kg/m² for those without (p=0.04). One-year death censored graft-survival was 81.25% for those that were on statins vs. 72.9% for those without (p=NS). Five-year graft-survival was also 11.7% higher in the statin group. Excluding patients with early graft loss (< 600 days) mean graft-survival was 646 days longer for patients receiving statins, with fewer cardiac events (p=0.02). For those with chronic rejection (n=9), mean graft survival of those on a statin was 309.5 days longer vs those without. Additionally, graft-survival was a mean of 575 days longer for patients that received atorvastatin vs no lipid-lowering agent (p=NS).

Conclusions: The use statins in the solitary pancreas transplant patient demonstrates both early anti-inflammatory effects and long term cardiovascular protection through prevention of the metabolic syndrome.