PCSK9 Inhibitors in Heart Transplant Recipients

BACKGROUND: Dyslipidemia is highly prevalent after heart transplantation (HT). We evaluated the efficacy and safety of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in a national cohort of HT recipients. METHODS: In this retrospective multicenter study, we included HT recipients from 8 centers in Spain. The primary analysis assessed changes in total and LDL cholesterol at 1 month. Secondary outcomes included the development of donor-specific HLA antibodies (DSA), coronary allograft vasculopathy (CAV), and rejection. RESULTS: Thirty-six HT recipients received PCSK9 inhibitors between May 2018 and September 2024. Median total cholesterol decreased from 195 mg/dL (170.5 to 233.5) to 124 mg/dL (96 to 156) at 1 month (reduction of 83 mg/dL [45 to 96]). Median LDL cholesterol decreased from 119.5 mg/dL (95 to 155) to 50 mg/dL (30 to 75; reduction of 71 mg/dL [43 to 97]). The prevalence of DSA, CAV, and rejection did not differ significantly before and after treatment (DSA: 20% vs 38.1%, P = .25; CAV: 30.56% vs 38.89%, P = .25; rejection: 19.4% vs 8.3%, P = .68). CONCLUSIONS: In HT recipients, PCSK9 inhibitors were associated with a marked reduction in LDL cholesterol, with no apparent safety signal. These findings support their use in patients with suboptimal lipid control, although their impact on clinical outcomes warrants further investigation.