*PURPOSE: Dyslipidemia affects up to 71% of liver transplant (LT) recipients. Patients with statin intolerance or refractory hyperlipidemia may be candidates for proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i), but data on PCSK9i use post-LT are limited. The purpose of this study was to assess safety and efficacy of PCSK9i in LT recipients within 1 year following treatment. *METHODS: We conducted a single-center, retrospective study of PCSK9i in patients with LT between 2004-2021. Safety from a LT perspective was evaluated by liver tests, immunosuppressant drug levels, and the tacrolimus concentration/dose (C/D) ratio; efficacy was assessed by lipid panels. Adverse events including atherosclerotic cardiovascular disease (ASCVD) and acute cellular rejection (ACR) were reviewed. Data were analyzed using summary statistics; paired tests evaluated post-PCSK9i change in lab values compared to the year preceding PCSK9i initiation. To adjust for familywise error in a preliminary sample, p-values < 0.01 were considered statistically significant. *RESULTS: The sample included 9 patients (age 67 ± 8 years, 55.6% female, BMI 30.4 ± 4.1 kg/m2) [Table]. On average, PSCK9i started 63.6 ± 46.8 months post-LT. Low-density lipoprotein and total cholesterol decreased after PCSK9i initiation (p < 0.001) [Figure 1a]. PCSK9i use was not associated with changes in triglycerides, liver or renal function, or serum glucose (p ≥ 0.031). There was no significant relationship between PCSK9i and tacrolimus trough levels or C/D ratios (p ≥ 0.028) [Figure 1b]. One patient discontinued PCSK9i on day 95 due to chest pain. One patient had ACR at 10.5 months post-PCSK9i. Two patients had transient ischemic attacks: one at 0.8 & 4.2 months, and one at 1.5 months. *CONCLUSIONS: This preliminary study suggests PCSK9i may be an efficacious option to treat hyperlipidemia in the LT population with limited impact on graft function and tacrolimus dosing. Future research would benefit from a larger sample for greater generalizability. [

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]CITATION INFORMATION: Potts M., Hamel S., Rega S., Feurer I., Scanga A. Use of PCSK9 Inhibitors in Liver Transplant Recipients: A Single-Center Review AJT, Volume 23, Issue 6, Supplement 1.

Marissa Potts DNP, FNP-C

Vanderbilt University Medical Center

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