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Framingham Risk Score predicts CV events, OS post-transplant

The Framingham Risk Score with adjusted renal function was accurate in predicting cardiovascular outcomes and overall survival post-liver transplantation, according to study data.

“Cardiovascular complications are emerging as the leading cause of non-graft-related death for long-term [liver transplant] recipient survivors,” Tommaso Di Maira, MD, Liver Transplantation and Hepatology Unit, La Fe Hospital, Valencia, Spain, told Healio.com/Hepatology. “This high incidence is likely the result of a combination of factors that include pre-existing diseases together with inadequate lifestyle habits and chronic exposure to immunosuppressive agents. We believe that cardiovascular risk assessment should become a priority, and significant changes should be implemented in many transplant centers.”

Marina Berenguer

Di Maira and colleagues, including Marina Berenguer, PhD, MD, conducted a retrospective analysis of 250 consecutive liver transplant patients undergoing LT at the Liver Transplant Unit of La Fe University Hospital in Valencia, Spain, between January 2006 and December 2008. Baseline features, cardiovascular (CV) risk factors, and cardiovascular events (CVEs) post-transplant, including ischemic heart disease, stroke, heart failure, de novo arrhythmias and peripheral arterial disease, were measured.

Results showed that at transplant, 34.4% of patients had low FRS, 34.4% had moderate FRS and 33.2% of patients had high FRS. The median FRS was 14.8 and increased to 22.5 1 year post-transplant.

“Fourteen-percent of LT recipients developed at least 1 CVE at a median of 2.6 years,” the researchers said.

Univariate analysis showed continuous FRS at LT (P = .003), age (P = .007), creatinine clearance [estimated glomerular filtration rate (eGFR); P = .020] and mycophenolate mofetil use at discharge (P = .011) to be factors associated with developing CVEs. Multivariate analysis showed only eGFR (HR=0.98; 95% CI, 0.97-1.00) and FRS (HR=1.06; 95% CI, 1.02-1.10) to be factors for developing CVEs.

In addition, FRS was associated with overall survival (P = .004), with 5-year survival rates of 82.5% in the low-risk group; 77.8% in the moderate-risk group; and 61.4% in the high-risk groups, respectively.

HCV, continuous FRS and eGFR were reported as independent risk factors for overall mortality.

“The Framingham Risk Score together with renal function were highly predictive not only of post-LT CV outcomes, but also of overall survival,” Berenguer said. “These findings are particularly important because a new CV risk score using the FRS adjusted for renal function might be a more reliable tool for correctly stratifying LT candidates into different risk categories of developing post-LT complications, and along with other risk factors, it may help identify patients in need of rigorous assessment before LT and close follow-up after LT.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.