Cerebrovascular events in 20 years of follow-up after liver transplantation: an underestimated issue?

ABSTRACT

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 6 months-10 years after LT (T1-T2) observed 11, expected 3.2; 10 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.