title: Cerebrovascular events in 20 years of follow-up after liver transplantation: an underestimated issue?
abstract: Cardio- and cerebrovascular diseases are the third leading cause of late death after liver transplantation (LT). A new score (PROCAM-Stroke) has been established to estimate the 10-year risk of cerebrovascular events (CBVE) in a German standard population. We evaluate the applicability of the PROCAM-Stroke for long-term follow-up after LT.
  
  
  
  A retrospective study of 313 consecutive LTs was conducted. Six months after LT (T1) and 10 years after LT (T2), CBVE risk factors were recorded and PROCAM-Stroke was calculated. Ten (T2) and 20 years (T3) after LT, recipients were screened regarding CBVE. PROCAM-Stroke estimates of CBVE were compared with the incidence of observed CBVE.
  
  
  
  In both 10-year time frames, the incidence of observed CBVE was higher than expected based on the PROCAM-Stroke estimates: 6 months-10 years after LT (T1-T2): observed: 11, expected: 3.2; 10 years-20 years after LT (T2-T3): observed: 7, expected: 3.4.
  
  
  
  LT recipients seem to have a considerably increased risk of CBVE. Long-term surveillance should take this into account, and screening may be extended accordingly. The progressive impairment of renal function in the long-term LT survivors may be one reason for the underestimation of CBVE in this patient group.
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, Charité, Campus Virchow Klinikum, Berlin, Germany. wschoening@ukaachen.de.|Department of General-, Visceral- and Transplantation Surgery, University Hospital of RWTH Aachen, Aachen, Germany. wschoening@ukaachen.de.
authors.forename: Wenzel
authors.initials: W
authors.lastname: Schoening
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, Charité, Campus Virchow Klinikum, Berlin, Germany.
authors.forename: Niklas
authors.initials: N
authors.lastname: Buescher
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, Charité, Campus Virchow Klinikum, Berlin, Germany.
authors.forename: Nadja
authors.initials: N
authors.lastname: Neidel
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, Charité, Campus Virchow Klinikum, Berlin, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Helbig
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, Charité, Campus Virchow Klinikum, Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Andreou
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, Charité, Campus Virchow Klinikum, Berlin, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Pascher
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, Charité, Campus Virchow Klinikum, Berlin, Germany.
authors.forename: Marcus
authors.initials: M
authors.lastname: Bahra
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, Charité, Campus Virchow Klinikum, Berlin, Germany.
authors.forename: Johann
authors.initials: J
authors.lastname: Pratschke
authors.affiliation: Department of General-, Visceral- and Transplantation Surgery, Charité, Campus Virchow Klinikum, Berlin, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Seehofer
mesh_terms: D000328:Adult; D000368:Aged; D002561:Cerebrovascular Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D003661:Decision Support Techniques; D005260:Female; D005500:Follow-Up Studies; D006305:Health Status Indicators; D006801:Humans; D015994:Incidence; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology
keywords: cerebrovascular events; cerebrovascular risk; liver transplantation; long-term follow-up; stroke