Klinisch I - P01 - Intima Media Thickness (IMT) and Major Adverse Cardiac Events (MACE) in patients after kidney transplantation

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M. van Dijk, A.M. van Roon, F.J. Bemelman, H.J.W. de Fijter, A.P.J. de Vries, J.J. Homan van der Heide, J.S.F Sanders

Chair(s): dr. Jan Stephan F. Sanders, internist/nefroloog, UMC Groningen

Thursday 10 march 2016

12:30 - 13:00h at Foyer

Categories: Postersessie

Parallel session: Postersessies XI - Opgesplitst in 3 tijdblokken en 3 categoriëen (klinisch, basaal, donatie)

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Background:
The MECANO trial, a prospective, randomized, multicenter trial in the Netherlands, was aiming to optimize immunosuppression (IS) and to reduce side effects. IMT was measured as a cardiovascular (c.v.) marker after kidney transplantation. Seven years survival and MACE-free survival probability were calculated by the Cardiovascular Risk Calculator for Renal Transplant Recipients. This sub study aimed to investigate IMT and MACE as predictors of survival and/or c.v. events.

Methods:
IMT of the arteria carotis communis was measured at week 2, month 6 and m. 24. Patients were treated with induction therapy (basiliximab) and triple IS (CsA(C), Myfortic(M), prednisolone(P)). At M6 patients were randomized to group 1 (C, P, N=81), 2(M, P, N=32) and 3 (Everolimus, P, N=81). MACE can be predicted using a 7-variable model including age, previous coronary heart disease (CHD), diabetes, low-density lipoprotein, creatinine, number of transplants, and smoking (pMACE). Mortality can be predicted by a 6-variable model, including age, CHD, diabetes, creatinine, total time on renal replacement therapy and smoking (pMort).

Results:
Mean IMT at baseline, N=192, for all patients was 0.64±0.14 mm. At M6, N=175, IMT was 0.65±0.15 and at M24 (N=111) IMT was 0.67±0.16. IMT of group 2 was significantly lower than the IMT of group 1 and 3 (ANOVA p=0.023 for baseline IMT, p=0.032 for IMT at M24). pMACE and pMort did not show a group difference. Both pMACE and pMort increased significantly with IMT quartile (ANOVA p<0.001). After correction for age, this increase was still present (p<=0.005).We predicted events and mortality after 7 years using pMACE, pMort, age and IMT. Best predictor is pMort with 79% classified correctly, including adding age in the regression, 81 % is classified correctly (n.s.).

Conclusion:
Higher IMT correlated with higher pMACE and pMort scores. However, prediction of events and mortality could not be improved by including IMT in the logistic regression model.