(variables included age, gender, blood pressure, HDL cholesterol, diabetes, current smoking)
FRS predicted IHD but underpredicted risk in some populations, especially diabetes; overall actual to predicted risk of IHD was 1.28 (CI 1.20–1.40; )
Sample population intentionally excluded angina pectoris and CHF, in contrast to the original Framingham cohort; IHD pretransplant and within the 1st year were also excluded; robust measures of performance were not included in this analysis.
(C-reactive protein and serum homocysteine also investigated)
Although the FRS predicted IHD in low-risk patients, it was underpredicted in high-risk patients: observed versus expected incidences were low-FRS = 0.6% versus 0.51%; high-FRS = 6.4% versus 2.8%
Sample population not identical to FRS; hypertension not significantly associated with CVD leading the authors to question sample size and follow up; c-statistics not used
FRS underestimated CVE across the entire cohort (observed to predicted risk 1.64 CI 1.19–2.94), but more so in patients aged 45–60 with CVD or diabetes (observed to predicted risk 2.74 CI 1.7–4.24)
Small number of events and sample limited ability to validate or develop new score; study used prevalent RTR > 6 months posttransplantation versus incident patients
PORT dataset used to identify CHD predictive risk factors to develop risk-prediction equations at clinically important time points
CHD defined as fatal or nonfatal AMI, coronary revascularization, or sudden death.
Retrospective cohort study (14 centers worldwide)
5 for FRS comparison*
kidney-only transplants; only centers that could report on required variables were included
18–34 years = 22% 35–49 years = 36% 50–64 years = 34% ≥65 = 8%
60% male 689 events in year 1; 669 events in years 1–5; 143 events for FRS comparison*
4.5 years
(data collected from Jan 1, 1990, to 2007)
2 models were developed to predict CV risk within 1 year and 1 model to predict risk within years 1–5 posttransplant (8, 7, and 12 variables, resp.)
The 3 models performed reasonably well with a time-dependent c-statistic of >0.75. Transplant related factors (e.g., DGR, AR, and eGFR) could predict CVE without FRS and FRS added little predicted value
Multicenter data with large sample size; models developed had many variables (8, 7, and 12), which predicted risk at clinically important time points. The model was not externally validated.
(C-reactive protein, uric acid, urine albumin-creatinine ratio also investigated)
FRS underpredicted events in all subgroups (actual to predicted event ratio was 1.2–8.4; ), but most notably in RTR with a history of diabetes or smoking. GFR was only non-FRS variable of predictive value after MVA (CRP, UA, and urine ACR did not).
Definition of MACE did not include angina or silent MI yet a much more inclusive definition was used for pretransplant CV history resulting in inconsistency; ethnicity was not accounted for as a confounder; small sample size
ALERT (a multicenter clinical trial) dataset used to develop and validate an equation for CV risk and mortality prediction in RTR
MACE defined by cardiac death, nonfatal MI, or coronary revascularization
Retrospective cohort study (multicenter-Northern Europe and Canada)
Renal and combined renal/pancreas, >6 months posttransplant; all were on CSA based IS, none were on statins: unstable angina within prior 6 months were excluded
50 ± 10.9 years
65.5% male () 165 events in total
6.7 years
A 7-year MACE and mortality calculator for RTR
Variables included age, CHD, SCr, LDL, smoking, diabetes, time on dialysis, and number of transplants
A formula for a 7-year MACE and mortality prediction was developed using a 7-variable model; MACE model had a c-statistic of 0.738 and 0.740 in the assessment and test samples, and mortality model had a c-statistic of 0.734 and 0.720 in assessment and test samples, respectively
MACE prediction tool developed from population specific variables in a sufficiently sized dataset; model was internally validated and discrimination and calibration were both reported; generalizability limited to dataset inclusion criteria
To externally validate the 7-year MACE and mortality calculators for RTR using the PORT dataset
MACE defined by cardiac death, nonfatal MI, or coronary revascularization
All patient follow-up was censored at graft loss.
Retrospective cohort study (Europe and the United States)
Kidney-only transplants; only centers that could report on required variables were included
Age and sex not reported
(211 events in total)
Median follow-up with functioning graft was 4.7 years (33% had at least 7 years of follow-up)
7-year MACE and mortality calculator for RTR
MACE could be predicted with a discrimination of 0.740 but calibration indicated significant underestimation in risk in decile 5 and 9; mortality c-statistic was 0.721; underestimation of risk in decile 7 and overestimation in the highest risk decile
External validation of the 7-year MACE and mortality calculator for renal transplants in a large database. Some limitations with respect to model performance which can be attributed to differences in datasets.
