Cardiovascular risk and events after liver transplantation. Experiences from 313 consecutive transplants with a follow-up of 20 years

Cardiovascular diseases (CVD) are the third leading cause of late death after liver transplantation (LT). The old PROCAM score was described in males (aged 35–65 yr) to estimate cardiovascular events after LT. New PROCAM is now available to estimate risks for cardiovascular events in both genders and for a wider age range (25–75 yr). We tested old and new PROCAM in long-term follow-up (10 and 20 yr) and described CVD risk factors, kidney function, and immunosuppression over two decades. A retrospective study of 313 consecutive LTs was conducted. At 10 (T2) and 20 (T3) yr, patients were screened for cardiovascular events, and for T1 (0.5 yr) and T2, CVD risk factors were recorded and old and new PROCAM calculated. PROCAM estimates were compared with observed events. CVD risk factors increased significantly over time and kidney function decreased. Between T1 and T2 in males, fewer events were observed (o) than estimated (e) (males: o: 3 vs. e: 6.05–9.88; females o: 2 vs. e: 1.35–4.21). For both genders, new PROCAM was appropriate between T2 and T3 (males o: 8; e: 4.5–8.57; females o: 2; e: 1.2–4.46). New PROCAM sufficiently estimates cardiovascular risk after LT, while overestimation in T1-T2 may be due to strict surveillance.