Asian Transplantation Week 2017
Liver Transplantation
Pretransplantation Cystatin C, but not Creatinine, Predicts 30-day Cardiovascular Events and Mortality in Liver Transplant Recipients With Normal Serum Creatinine Levels

https://doi.org/10.1016/j.transproceed.2018.01.049Get rights and content

Highlights

  • The superiority of cystatin C over creatinine in renal assessment, especially detecting mild renal dysfunction, in cirrhotic population has been reported but the ability to predict prognosis has not been examined previously.

  • We observed that cystatin C, but not creatinine, was an independent predictor of major cardiovascular events and all-cause mortality after liver transplantation in patients with normal creatinine levels.

  • Our findings suggest that cystatin C may be an additional prognostic tool in cirrhotic population with mild renal dysfunction, which may have not been revealed with traditional serum creatinine measurements.

Abstract

Background

The connection between renal dysfunction and cardiovascular dysfunction has been consistently shown. In patients with liver cirrhosis, renal dysfunction shows a tight correlation with prognosis after liver transplantation (LT); therefore, precise renal assessment is mandatory. Cystatin C, a sensitive biomarker for assessing renal function, has shown superiority in detecting mild renal dysfunction compared to classical biomarker creatinine. In this study, we aimed to compare cystatin C and creatinine in predicting 30-day major cardiovascular events (MACE) and all-cause mortality in LT recipients with normal serum creatinine levels.

Patients and Methods

Between May 2010 and October 2015, 1181 LT recipients (mean Model for End-stage Liver Disease score 12.1) with pretransplantation creatinine level ≤1.4 mg/dL were divided into tertiles according to each renal biomarker. The 30-day MACE was a composite of troponin I >0.2 ng/mL, arrhythmia, congestive heart failure, death, and cerebrovascular events.

Results

The highest tertile of cystatin C (≥0.95 mg/L) was associated with a higher risk for a 30-day MACE event (odds ratio: 1.62; 95% confidence interval: 1.07 to 2.48) and higher risk of death (hazard ratio: 1.96; 95% confidence interval: 1.04 to 3.67) than the lowest tertile (<0.74 mg/L) after multivariate adjustments. However, the highest tertile of creatinine level showed neither increasing MACE event rate nor worse survival rate compared with the lowest tertile (both insignificant after multivariate adjustment).

Conclusions

Pretransplantation cystatin C is superior in risk prediction of MACE and all-cause mortality in LT recipients with normal creatinine, compared to creatinine. It would assist further risk stratification which may not be detected with creatinine.

Section snippets

Patients and Methods

This is a retrospective study comprising patients undergoing living-donor LT at Asan Medical Center from May 2010 and October 2015. After excluding patients with sCr level >1.4 mg/dL, those younger than 18 years, or those with a previous history of cardiac surgery, a total of 1181 patients were enrolled. The patients were categorized into tertiles according to Cys-C and sCr levels. The primary end points were 30-day MACE and all-cause mortality observed until November 2015. The 30-day MACE was

Results

Among the total of 1181 LT recipients (mean age, 53 ± 8 years), 880 were males (75%) and 301 were females (25%). The median [interquartile range] Cys-C and sCr levels were 0.74 mg/L [0.62–0.89 mg/L] and 0.82 mg/dL [0.69–1.01 mg/dL], respectively. Among the total patients, 226 (19.1%) developed a 30-day MACE and 61 (5.2%) died during a mean follow-up of 25 ± 16 months after LT. Patients in the highest tertile of Cys-C were older, were females, had a higher chance of taking diuretics, and had

Discussion

In the current study, we showed the superiority of Cys-C as a potential prognostic factor, compared with sCr, analyzing in accurate postoperative risk stratification. The results showed that, after dividing the patients into tertiles according to Cys-C levels (≤0.74, 0.75–0.94, and ≥0.95 mg/L), higher Cys-C was an independent prognostic factor in predicting MACE. Furthermore, higher Cys-C was significantly and independently associated with a higher risk of all-cause mortality compared with sCr.

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