Introduction Patients with type 1 diabetes mellitus and renal failure have increased mortality risk. Simultaneous Pancreas and Kidney transplantation (SPKT) provides survival benefit, but premature mortality in people with functioning grafts remains a concern. QRISK2 is a UK-based risk calculator estimating the proportion of individuals predicted to experience a major adverse cardiovascular event (MACE) over 10 years in the general population. QRISK2 was designed to take into account the effects of social deprivation on cardiovascular disease. A threshold of ≥20% indicates very high cardiovascular disease (CVD) risk. This study assessed the relationship between the QRISK2 score, mortality and MACE following SPKT.

Methods All patients receiving SPKT in a single unit between 2000-2015 were included.. Prospectively collected pre-transplant data were used to calculate the QRISK2 score. Individual CVD risk factors and QRISK2 scores were related to all cause mortality and MACE using Cox regression.

Results 306 patients were included with a total mortality of 20% (n=61); 40 deaths (66%) occurred with functioning grafts. 20 patients (6.5%) experienced a MACE, 7 of which were fatal. The median time to MACE was 1773 days (interquartile range: 100-3894). In unadjusted models, baseline age (hazard ratios [HR]: 1.04), hypertension (HTN; HR: 2.6), ischaemic heart disease (IHD; HR: 2.0), peripheral neuropathy (HR: 1.8) and the QRISK2 score (HR: 1.03 per % increment) were significantly associated with mortality (p<0.05 for all). Age, IHD and baseline QRISK2 score were significantly related to incident MACE in univariate analyses (HRs: 1.05, 2.89, 1.04 respectively, all p<0.05). Patients with a QRISK2 score ≥20% had twice the mortality rate compared to those with a score <20% (HR (95% confidence interval [CI]): 2.1 (1.09-4.02), p=0.027), and a 9-fold increase in the risk of MACE (HR: 8.732 (1.168-65.272), p=0.035).

Conclusion The baseline QRISK2 score significantly relates to the risk of mortality and MACE in SPKT recipients. Patients with a score of ≥20% may benefit from cardiovascular prehabilitation and risk factor optimisation before transplantation to minimise subsequent adverse events.

CITATION INFORMATION: Yiannoullou P., Goh S., Khambalia H., Moinuddin Z., Summers A., Shapey I., Fullwood C., Augustine T., Rutter M., van Dellen D. Identifying Patients at Risk of Mortality and Major Adverse Cardiovascular Events Following Simultaneous Pancreas and Kidney Transplantation Using the Pre-Transplant QRISK2 Score Am J Transplant. 2017;17 (suppl 3).

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