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Glomerular filtration rate early after liver transplantation independently predicts atherosclerotic events
Ramzi Hassouneh1, Samarth Patel2, Steve Shen3
16889Department of Internal MedicineVirginia Commonwealth UniversityRichmondVirginiaUSA.
Insights
Decline in kidney function six months after liver transplantation predicts atherosclerotic events. This finding is independent of traditional cardiovascular disease risk factors, suggesting a new approach for risk assessment in transplant patients.
Area of Science:
- Nephrology
- Cardiology
- Transplantation Medicine
Background:
- Cardiovascular disease (CVD) is a leading cause of mortality in liver transplant (LT) recipients.
- Limited data exists on CVD risk stratification specifically for LT patients.
- Early post-transplant renal function is a potential, understudied predictor of long-term outcomes.
Purpose of the Study:
- To investigate the association between early post-LT renal function and the incidence of atherosclerotic events.
- To determine if estimated glomerular filtration rate (GFR) six months after LT can predict major adverse cardiovascular events (MACE).
- To assess the independence of this association from traditional CVD risk factors and models like the Framingham Risk Score (FRS).
Main Methods:
- Retrospective analysis of 553 liver transplant recipients between 2007 and 2019.
- Quantification of early renal function using estimated glomerular filtration rate (GFR) at six months post-LT.
- Primary endpoint defined as a composite of three-point major adverse cardiovascular events (MACE-3): nonfatal myocardial infarction, nonfatal stroke, or cardiovascular death.
Main Results:
- A significant inverse relationship was observed between early GFR and MACE-3.
- A decrease in GFR at six months post-LT was a strong predictor of MACE-3, even after adjusting for traditional risk factors (HR 0.96 per unit increase in GFR, p<0.0001).
- An independent interaction was found between GFR, FRS, and the likelihood of MACE-3, highlighting GFR's unique predictive value.
Conclusions:
- Early post-liver transplant renal function, specifically GFR at six months, is a robust predictor of subsequent atherosclerotic events.
- This predictive capability is independent of established CVD risk stratification tools like the FRS.
- Incorporating early GFR into CVD risk assessment models for LT recipients warrants further investigation and validation.
Abstract:
Cardiovascular disease (CVD) is an important cause of mortality among liver transplantation (LT) recipients; however, the data on CVD risk stratification following LT are limited. Thus, the primary aim of this study was to evaluate the association between decline in renal function early after LT and atherosclerotic events. This retrospective study included all patients receiving LT between 2007 and 2019. Early renal function was quantified as estimated glomerular filtration rate (GFR) 6 months after LT. The primary endpoint for the study was a composite atherosclerotic cardiovascular event of three-point major adverse cardiovascular events (MACEs), which includes nonfatal myocardial infarction (MI), nonfatal stroke, or death from CVD. A total of 553 LT recipients met entry criteria. After a median follow-up of 74 months (interquartile range 46-111), 94 (17%) LT recipients died and CVD-associated death occurred in 20 patients. MACE-3 occurred in 66 (12%) patients, with nonfatal MI being the most common event (n = 30). A strong inverse relationship between early GFR and MACE-3 was noted in unadjusted analysis with hazard ratio (HR) 0.96 (95% confidence interval [CI] 0.95-0.98; p = 0.0001) and remained significant even after accounting for age, sex, coronary artery disease, diabetes mellitus, hypertension, calcineurin inhibitor use, and Framingham Risk Score (FRS; HR 0.96, 95% CI 0.95-0.97; p = 0.0001 per unit increase in GFR). Furthermore, an independent interaction between GFR, FRS, and likelihood of developing an MACE-3 was noted. GFR 6 months following LT is a strong predictor of developing atherosclerotic events. This relationship is independent of traditional CVD risk stratification models (e.g. FRS) and thus has the potential to be incorporated into CVD risk assessment after LT but requires further validation.
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