Title: VALIDATION OF CARDIOVASCULAR RISK SCORES IN LIVER TRANSPLANT RECIPIENTS
1VALIDATION OF CARDIOVASCULAR RISK SCORES IN LIVER
TRANSPLANT RECIPIENTS
- Olaf Guckelberger, Florian Mutzke, Jan M
Langrehr, Jochen Klupp,Ulf P Neumann, Matthias
Glanemann, Ruth Neuhaus, Peter Neuhaus - Dept. of Surgery, Charité - Campus
Virchow-Klinikum,Berlin, Germany
2Cardiovascular risk afterliver transplantation
- High prevalence of cardiovascular risk factors
- Attributed to CNI and steroid medication
- Cardiovascular disease is among the most common
causes for late graft loss
3Cardiovascular disease inliver transplant
populations
- Birmingham (Johnston Transplantation, 2002)
- Risk of CHD 3.07 (1.98 4.53)
- Follow-up 45.6 months
- Cambridge (Neal Transplantation, 2004)
- Risk of MI 0.55 (0.01 3.06)
- Risk of stroke 1.45 (0.18 5.22)
- Follow-up 54 months (6 90)
- Berlin (Guckelberger Transplant Int, 2005)
- Risk standardized rate of CHD 1.11 (0.53 2.03)
- Follow-up 10 years
4Questions
- Which variables predict cardiovascular events in
a liver transplant population?
5Patients
- 303 adult patients (128 female, 175 male)
- Liver transplantation 9/1988 4/1994
- Cardiovascular risk factors _at_ 6 months
- Age 48 years (16 66)
- Follow-up 10 years
6Cardiovascular events
- 40 cardiovascular events (13.2)
- 24 coronary events (7.9)
- 4 fatalities
- 24 events beyond 5 years of follow-up(60 of
events)
7Univariate analysis of risk factors
- Age plt0.001
- Gender p0.002
- Body-mass-index p0.018
- Cholesterol p0.044
- Creatinine p0.006
- Diabetes mellitus p0.017
- Glucose p0.006
- Systolic blood pressure p0.043
- Ciclosporine A p0.743
- Tacrolimus p0.870
- Steroid medication p0.991
8Multivariate analysis of risk factors
9Questions
- Do established cardiovascular risk scores predict
cardiovascular events in a liver transplantation?
-
- Traditional cardiovascular risk factors
- Which variables predict cardiovascular events in
a liver transplant population?
10Framingham Risk Score
- 93 patients eligible
- AUC 0.707
- Low discrimination capability for high risk
patients
Variables gender, age, cholesterol,
HDL-cholesterol, systolic blood pressure, smoking
status
11Prospective Cardiovascular Münster Study (PROCAM)
- Discrimination
- 67 patients eligible
- AUC 0.778
Variables gender, age, LDL-cholesterol,
HDL-cholesterol, triglycerids, systolic blood
pressure,smoking status, diabetes mellitus,
family history of CHD
12European Systematic Coronary Risk Evaluation
Project (SCORE) - Discrimination
- 126 patients eligible
- AUC 0.800
Variables gender, age, total cholesterol,
systolic blood pressure, smoking status
13European Systematic Coronary Risk Evaluation
Project (SCORE) - Calibration
- SCORE Endpoint fatal coronary events
- Strong underestimation in low and very high risk
patients
14Prospective Cardiovascular Münster Study (PROCAM)
- Calibration
- Overestimation in very low and low risk patients
- RR 0.887(0.241 1.532)
15Summary
- Predictors of cardiovascular events in liver
transplant recipients do not differ from those in
general populations - Framingham Risk Score did not discriminate well
between high and low risk individuals in our
(European) liver transplant population - SCORE and PROCAM demonstrated an improved
discrimination capability
16Summary
- SCORE calculation included the highest number of
patients - Retrospective analysis
- Follow-up studies
- PROCAM calibrated well with our liver transplant
population - Prospective interventional trials
- Individual risk determination