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

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)

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.

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).

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.).

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.