title: Cardiovascular risk and events after liver transplantation. Experiences from 313 consecutive transplants with a follow-up of 20 years.
abstract: Cardiovascular diseases (CVD) are the third leading cause of late death after liver transplantation (LT). The old PROCAM score was described in males (aged 35-65 yr) to estimate cardiovascular events after LT. New PROCAM is now available to estimate risks for cardiovascular events in both genders and for a wider age range (25-75 yr). We tested old and new PROCAM in long-term follow-up (10 and 20 yr) and described CVD risk factors, kidney function, and immunosuppression over two decades. A retrospective study of 313 consecutive LTs was conducted. At 10 (T2) and 20 (T3) yr, patients were screened for cardiovascular events, and for T1 (0.5 yr) and T2, CVD risk factors were recorded and old and new PROCAM calculated. PROCAM estimates were compared with observed events. CVD risk factors increased significantly over time and kidney function decreased. Between T1 and T2 in males, fewer events were observed (o) than estimated (e) (males: o: 3 vs. e: 6.05-9.88; females o: 2 vs. e: 1.35-4.21). For both genders, new PROCAM was appropriate between T2 and T3 (males o: 8; e: 4.5-8.57; females o: 2; e: 1.2-4.46). New PROCAM sufficiently estimates cardiovascular risk after LT, while overestimation in T1-T2 may be due to strict surveillance.
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, Charité, Berlin, Germany.
authors.forename: Wenzel
authors.initials: W
authors.lastname: Schoening
authors.forename: Nadja
authors.initials: N
authors.lastname: Neidel
authors.forename: Niklas
authors.initials: N
authors.lastname: Buescher
authors.forename: Andreas
authors.initials: A
authors.lastname: Andreou
authors.forename: Andreas
authors.initials: A
authors.lastname: Pascher
authors.forename: Daniel
authors.initials: D
authors.lastname: Seehofer
authors.forename: Marcus
authors.initials: M
authors.lastname: Bahra
authors.forename: Volker
authors.initials: V
authors.lastname: Schmitz
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
authors.forename: Gero
authors.initials: G
authors.lastname: Puhl
mesh_terms: D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006334:Heart Function Tests; D006801:Humans; D017093:Liver Failure / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
keywords: cardiovascular risk; liver transplantation; long-term follow-up