title: Framingham score, renal dysfunction, and cardiovascular risk in liver transplant patients.
abstract: Cardiovascular (CV) events represent major impediments to the long-term survival of liver transplantation (LT) patients. The aim of this study was to assess whether the Framingham risk score (FRS) at transplantation can predict the development of post-LT cardiovascular events (CVEs). Patients transplanted between 2006 and 2008 were included. Baseline features, CV risk factors, and CVEs occurring after LT (ischemic heart disease, stroke, heart failure, de novo arrhythmias, and peripheral arterial disease) were recorded. In total, 250 patients (69.6% men) with a median age of 56 years (range, 18-68 years) were included. At transplantation, 34.4%, 34.4%, and 33.2% of patients, respectively, had a low, moderate, and high FRS with a median FRS of 14.9 (range, 0.09-30); 14.4% of LT recipients developed at least 1 CVE at a median of 2.619 years (range, 0.006-6.945 years). In the univariate analysis, factors associated with the development of CVEs were the continuous FRS at LT (P = 0.003), age (P = 0.007), creatinine clearance [estimated glomerular filtration rate (eGFR); P = 0.020], and mycophenolate mofetil use at discharge (P = 0.011). In the multivariate analysis, only the eGFR [hazard ratio (HR), 0.98; 95% confidence interval (CI), 0.97-1.00; P = 0.009] and FRS (HR, 1.06; 95% CI, 1.02-1.10; P = 0.002) remained in the model. Moreover, an association was also found between the FRS and overall survival (P = 0.004) with 5-year survival rates of 82.5%, 77.8%, and 61.4% for the low-, moderate-, and high-risk groups, respectively. Continuous FRS, eGFR, and hepatitis C virus infection were independent risk factors for overall mortality. In our series, the FRS and eGFR at LT were able to predict the development of post-LT CVEs and poor outcomes. Liver Transpl 21:812-822, 2015. © 2015 AASLD.
authors.affiliation: Liver Transplantation and Hepatology Unit, La Fe Hospital, Valencia, Spain.|Gastroenterology Unit, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Tommaso
authors.initials: T
authors.lastname: Di Maira
authors.affiliation: Liver Transplantation and Hepatology Unit, La Fe Hospital, Valencia, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Rubin
authors.affiliation: Liver Transplantation and Hepatology Unit, La Fe Hospital, Valencia, Spain.
authors.forename: Lorena
authors.initials: L
authors.lastname: Puchades
authors.affiliation: Liver Transplantation and Hepatology Unit, La Fe Hospital, Valencia, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Valencia, Spain.
authors.forename: Victoria
authors.initials: V
authors.lastname: Aguilera
authors.affiliation: Liver Transplantation and Hepatology Unit, La Fe Hospital, Valencia, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Vinaixa
authors.affiliation: Liver Transplantation and Hepatology Unit, La Fe Hospital, Valencia, Spain.
authors.forename: Maria
authors.initials: M
authors.lastname: Garcia
authors.affiliation: Gastroenterology Unit, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: De Maria
authors.affiliation: Gastroenterology Unit, Azienda Ospedaliero-Universitaria, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Erica
authors.initials: E
authors.lastname: Villa
authors.affiliation: Hepatic Surgery and Liver Transplant Unit, and, La Fe University Hospital, Valencia, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Lopez-Andujar
authors.affiliation: Hepatic Surgery and Liver Transplant Unit, and, La Fe University Hospital, Valencia, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: San Juan
authors.affiliation: Hepatic Surgery and Liver Transplant Unit, and, La Fe University Hospital, Valencia, Spain.
authors.forename: Eva
authors.initials: E
authors.lastname: Montalva
authors.affiliation: Department of Pathology and Anatomy, La Fe University Hospital, Valencia, Spain.
authors.forename: Judith
authors.initials: J
authors.lastname: Perez
authors.affiliation: Liver Transplantation and Hepatology Unit, La Fe Hospital, Valencia, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Valencia, Spain.
authors.forename: Martin
authors.initials: M
authors.lastname: Prieto
authors.affiliation: Liver Transplantation and Hepatology Unit, La Fe Hospital, Valencia, Spain.|Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Valencia, Spain.|Faculty of Medicine, University of Valencia, Valencia, Spain.
authors.forename: Marina
authors.initials: M
authors.lastname: Berenguer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D005919:Glomerular Filtration Rate; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007668:Kidney / Q000503:physiopathology*; D007674:Kidney Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D066027:Transplant Recipients; D016896:Treatment Outcome; D055815:Young Adult