The Framingham Risk Score Is Associated with Chronic Graft Failure in Renal Transplant Recipients.

Josephine L C Anderson,Uwe J F Tietge,Stephan J L Bakker,Margot L Poot,Daan Kremer,Hannah L M Steffen

doi:10.3390/jcm10153287

Abstract

Predicting chronic graft failure in renal transplant recipients (RTR) is an unmet clinical need. Chronic graft failure is often accompanied by transplant vasculopathy, the formation of de novo atherosclerosis in the transplanted kidney. Therefore, we determined whether the 10-year Framingham risk score (FRS), an established atherosclerotic cardiovascular disease prediction module, is associated with chronic graft failure in RTR. In this prospective longitudinal study, 600 well-characterised RTR were followed for 10 years. The association with death-censored chronic graft failure (n = 81, 13.5%) was computed. An extended Cox model showed that each one percent increase of the FRS significantly increased the risk of chronic graft failure by 4% (HR: 1.04, p < 0.001). This association remained significant after adjustment for potential confounders, including eGFR (HR: 1.03, p = 0.014). Adding the FRS to eGFR resulted in a higher AUC in a receiver operating curve (AUC = 0.79, p < 0.001) than eGFR alone (AUC = 0.75, p < 0.001), and an improvement in the model likelihood ratio statistic (67.60 to 88.39, p < 0.001). These results suggest that a combination of the FRS and eGFR improves risk prediction. The easy to determine and widely available FRS has clinical potential to predict chronic graft failure in RTR.

Highlights

The number of patients with end-stage renal disease (ESRD) has been growing unwaveringly over the past decades [1], resulting in a rising demand for donor kidneys
All statistical analyses were performed using Stata version 15. In this prospective longitudinal study, the Framingham risk score (FRS) was assessed as a potential clinical tool for predicting graft failure in 600 renal transplant recipients
A high body weight, Body Mass Index (BMI) and higher levels of hs-CRP were associated with a higher FRS (p < 0.001)

Summary

Introduction

The number of patients with end-stage renal disease (ESRD) has been growing unwaveringly over the past decades [1], resulting in a rising demand for donor kidneys. Even after transplantation RTR still face major clinical problems, namely graft failure and a 4–6-fold increased incidence of cardiovascular disease (CVD) [3], the leading cause of death with a functioning graft [4]. Substantial clinical progress has been made over the past decades regarding acute rejection, but clinical advances concerning chronic graft failure stagnated, eventually leading to return to haemodialysis or re-transplantation in substantial numbers of patients [5]. Atherosclerosis negatively impacts RTR in two distinct ways, as classic atherosclerosis underlying CVD events and as de-novo atherosclerosis in the form of TV

Methods

Results

Conclusion