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Updated: Aug 11, 2026
Porcine Liver Transplantation Without Veno-Venous Bypass As an Extended Criteria Donor Model
Published on: August 17, 2022
Validation of cardiovascular risk scores in a liver transplant population
Olaf Guckelberger1, Florian Mutzke, Matthias Glanemann
1Department of General, Visceral and Transplantation Surgery, Charité-Campus Vichow-Klinikum, Berlin, Germany. olaf@guckelberger.charite.de
Insights
Liver transplant recipients face cardiovascular risks. Age, gender, and cholesterol independently predict events, with SCORE and PROCAM scores aiding risk assessment in these patients.
Area of Science:
- Cardiology
- Transplantation Medicine
- Medical Statistics
Background:
- Liver transplant recipients exhibit a higher prevalence of cardiovascular risk factors.
- The incidence of cardiovascular events is suspected to be elevated in this population.
- Individual risk stratification for cardiovascular events remains unestablished.
Purpose of the Study:
- To investigate cardiovascular risk factors in liver transplant recipients.
- To evaluate the effectiveness of established cardiovascular risk scores in this cohort.
- To identify independent predictors of cardiovascular events post-liver transplantation.
Main Methods:
- Retrospective review of outpatient charts from 438 primary liver transplant recipients.
- Correlation of suspected cardiovascular risk factors with observed cardiovascular events over a 10-year follow-up.
- Receiver Operating Characteristic (ROC) curve analysis to validate risk scores (SCORE, PROCAM, Framingham Risk Score).
- Hosmer-Lemeshow test for calibration and goodness of fit.
Main Results:
- Out of 303 patients with complete follow-up, 40 (13.2%) experienced cardiovascular events.
- Univariate analysis identified age, gender, BMI, cholesterol, creatinine, diabetes, glucose, and systolic blood pressure as significant factors.
- Multivariate analysis revealed age, gender, and cholesterol as independent predictors.
- ROC analysis showed areas under the curve of 0.800 for SCORE, 0.778 for PROCAM, and 0.707 for Framingham Risk Score.
- PROCAM demonstrated better calibration than SCORE.
Conclusions:
- Systematic Coronary Risk Evaluation (SCORE) and Prospective Cardiovascular Münster Study (PROCAM) risk scores are valuable for discriminating cardiovascular event risk in liver transplant recipients.
- Calibrated PROCAM risk estimates are necessary for planning future intervention trials.
- Age, gender, and cholesterol are key independent predictors of cardiovascular events in this population.
Abstract:
Increased prevalence of cardiovascular risk factors has been acknowledged in liver transplant recipients, and an increased incidence of cardiovascular events has been suspected. Individual risk determination, however, has not yet been established. Outpatient charts of 438 primary liver transplants have been reviewed, and suspected cardiovascular risk factors were correlated with cardiovascular events observed during a follow-up period of 10 yr. Receiver operation characteristics curve (ROC) analysis was performed to validate established cardiovascular risk scores. For calibration, the Hosmer-Lemeshow test was performed. A total of 303 of 438 patients were available for risk factor analysis at 6 months and demonstrated complete follow-up data (175 male, 128 female). A total of 40 of those 303 patients experienced fatal or nonfatal cardiovascular events (13.2%). In univariate analysis, age (P < 0.001), gender (P = 0.002), body mass index (P = 0.018), cholesterol (P = 0.044), creatinine (P = 0.006), diabetes mellitus (P = 0.017), glucose (0.006), and systolic blood pressure (P = 0.043), but not cyclosporine A (P = 0.743), tacrolimus (P = 0.870), or steroid medication (P = 0.991), were significantly associated with cardiovascular events. Multivariate analysis, however, identified only age, gender, and cholesterol as independent predictors. In ROC analysis, corresponding areas under the curve for Systematic Coronary Risk Evaluation Project (SCORE), Prospective Cardiovascular Münster Study (PROCAM), and Framingham risk scores (FRSs) were calculated with 0.800, 0.778, and 0.707, respectively. Calibration demonstrated an improved goodness of fit for PROCAM compared to SCORE risk calculations. In conclusion, SCORE and PROCAM proved to be valuable in discriminating our liver transplant recipients for their individual risk of cardiovascular events. Furthermore, calibrated PROCAM risk estimates are required to calculate the number of patients needed to treat in the setup of prospective intervention trials.
