Schoening W, Buescher N, Neidel N, Helbig M, Andreou A, Pascher A, Bahra M, Pratschke J, Seehofer D

BACKGROUND 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.

PATIENTS AND METHODS 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.

RESULTS In both 10-year time frames the incidence of observed CBVE was higher than expected based on the PROCAM-stroke estimates: Six months - 10 years after LT (T1-T2): observed: 11, expected: 3.2; Ten years - 20 years after LT (T2-T3): observed: 7, expected: 3.4.

CONCLUSION 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.

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