The goal of this postdoctoral fellowship is to facilitate the candidate's development as a leader in transplantation outcomes research, with a focus on perioperative cardiovascular (CV) risk assessment. Building on her background in internal medicine, transplant hepatology, and clinical investigation, the candidate proposes to develop additional skills during the award period through (1) coursework designed to expand her methodological skills;(2) interaction with a multidisciplinary team of sponsors and collaborators, including those in cardiovascular epidemiology, risk assessment, transplantation outcomes, and health services research;and (3) a supervised research project. The overall objective of this project is to define and optimize a preoperative cardiovascular risk assessment model for orthotopic liver transplant (OLT) candidates through two primary specific aims: (1) To determine if a national liver transplant-specific Cardiovascular Risk Index (NOLT-CRI) improves the predictive utility of the commonly used revised cardiac risk index (RCRI) by (1.1) determining the discrimination (C-statistic) and calibration (Hosmer-Lemeshow statistic) of the RCRI as a model of 30-day CV events using secondary data analysis of a national database;and (1.2) comparing the clinical performance of the NOLT-CRI to the RCRI in its ability to reclassify 30-day CV risk and to stratify 1- year survival across the continuum of predicted 30-day CV risk;(2) To determine whether additional variables are needed beyond those available within a national database in order to improve the predictive ability of these models by (2.1) determining the model discrimination and calibration of a locally-derived cardiac risk index (LOLT-CRI) using a center-specific database with more detailed clinical data than are currently available nationally;and (2.2) comparing the clinical performance of the LOLT-CRI to the national models in its ability to reclassify risk. This project will meet the mission of the National Institutes of Healthby identifying cardiovascular disease markers that are unique to the liver transplant candidate, which can then be used to improve pre- and post-transplant medical management in this growing patient population. The project, along with the chosen coursework and mentorship, will allow the candidate to become proficient at data management and statistical methodology. Near the end of the award period, the candidate plans to submit a career development award using the results of the project to develop a cardiovascular risk assessment treatment algorithm for use prior to liver transplantation.

Public Health Relevance

Orthotopic liver transplantation (OLT) is a life-saving procedure for patients with end-stage liver disease, but it is not universally available to the public due to a scarcity of donor organs. Cardiovascular disease is an increasing public health problem and is often responsible for severe complications following OLT. This project will benefit public health by assessing the impact of cardiovascular disease on outcomes after OLT and by determining risk predictors for poor outcomes in order to improve the clinical management of OLT recipients in order to maximize the benefit of scarce donor organs.

National Institute of Health (NIH)
National Heart, Lung, and Blood Institute (NHLBI)
Postdoctoral Individual National Research Service Award (F32)
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Special Emphasis Panel (ZRG1-F10A-S (20))
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Meadows, Tawanna
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Northwestern University at Chicago
Internal Medicine/Medicine
Schools of Medicine
United States
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VanWagner, Lisa B; Montag, Samantha; Zhao, Lihui et al. (2018) Cardiovascular Disease Outcomes Related to Early Stage Renal Impairment After Liver Transplantation. Transplantation 102:1096-1107
Bittermann, T; Hubbard, R A; Serper, M et al. (2018) Healthcare utilization after liver transplantation is highly variable among both centers and recipients. Am J Transplant 18:1197-1205
VanWagner, Lisa B (2018) A simple clinical calculator for assessing cardiac event risk in liver transplant candidates: The cardiovascular risk in orthotopic liver transplantation score. Clin Liver Dis (Hoboken) 11:145-148
VanWagner, Lisa B; Ning, Hongyan; Whitsett, Maureen et al. (2017) A point-based prediction model for cardiovascular risk in orthotopic liver transplantation: The CAR-OLT score. Hepatology 66:1968-1979
Veerappan, Annapoorani; VanWagner, Lisa B; Mathew, James M et al. (2016) Low incidence of acute rejection in hepatitis B virus positive liver transplant recipients and the impact of hepatitis B immunoglobulin. Hum Immunol 77:367-74
VanWagner, L B; Serper, M; Kang, R et al. (2016) Factors Associated With Major Adverse Cardiovascular Events After Liver Transplantation Among a National Sample. Am J Transplant 16:2684-94
VanWagner, Lisa B; Lapin, Brittany; Skaro, Anton I et al. (2015) Impact of renal impairment on cardiovascular disease mortality after liver transplantation for nonalcoholic steatohepatitis cirrhosis. Liver Int 35:2575-83
VanWagner, Lisa B; Wilcox, Jane E; Colangelo, Laura A et al. (2015) Association of nonalcoholic fatty liver disease with subclinical myocardial remodeling and dysfunction: A population-based study. Hepatology 62:773-83
VanWagner, Lisa B; Green, Richard M (2015) Evaluating elevated bilirubin levels in asymptomatic adults. JAMA 313:516-7
VanWagner, Lisa B; Ning, Hongyan; Lewis, Cora E et al. (2014) Associations between nonalcoholic fatty liver disease and subclinical atherosclerosis in middle-aged adults: the Coronary Artery Risk Development in Young Adults Study. Atherosclerosis 235:599-605

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