VALIDATION OF CARDIOVASCULAR RISK SCORES IN LIVER TRANSPLANT RECIPIENTS - PowerPoint PPT Presentation

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VALIDATION OF CARDIOVASCULAR RISK SCORES IN LIVER TRANSPLANT RECIPIENTS

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Olaf Guckelberger, Florian Mutzke, Jan M Langrehr, Jochen Klupp, Ulf P Neumann, Matthias Glanemann, Ruth Neuhaus, Peter Neuhaus ... – PowerPoint PPT presentation

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Title: VALIDATION OF CARDIOVASCULAR RISK SCORES IN LIVER TRANSPLANT RECIPIENTS


1
VALIDATION 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

2
Cardiovascular 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

3
Cardiovascular 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

4
Questions
  • Which variables predict cardiovascular events in
    a liver transplant population?

5
Patients
  • 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

6
Cardiovascular events
  • 40 cardiovascular events (13.2)
  • 24 coronary events (7.9)
  • 4 fatalities
  • 24 events beyond 5 years of follow-up(60 of
    events)

7
Univariate 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

8
Multivariate analysis of risk factors
9
Questions
  • 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?

10
Framingham 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
11
Prospective 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
12
European Systematic Coronary Risk Evaluation
Project (SCORE) - Discrimination
  • 126 patients eligible
  • AUC 0.800

Variables gender, age, total cholesterol,
systolic blood pressure, smoking status
13
European Systematic Coronary Risk Evaluation
Project (SCORE) - Calibration
  • SCORE Endpoint fatal coronary events
  • Strong underestimation in low and very high risk
    patients

14
Prospective Cardiovascular Münster Study (PROCAM)
- Calibration
  • Overestimation in very low and low risk patients
  • RR 0.887(0.241 1.532)

15
Summary
  • 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

16
Summary
  • 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
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