Incidence and predictors of sudden cardiac death after heart transplantation: A systematic review and meta-analysis

Ana C. Alba, Farid Foroutan, Nicholas Kwet Vong Ng Fat Hing, Chun Po S. Fan, Cedric Manlhiot, Heather J. Ross

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: Sudden cardiac death (SCD) is an important post-transplant problem being responsible for ~10% of deaths. We conducted a systematic review and meta-analysis to evaluate incidence and predictors of post-heart transplant SCD and the use of implantable cardiac defibrillator (ICD). Methods: Citations were identified in electronic databases and references of included studies. Observational studies on adults reporting on incidence and predictors of post-transplant SCD and ICD use were selected. We meta-analyzed SCD in person-years using random effects models. We qualitatively summarized predictors. Results: This study includes 55 studies encompassing 47 901 recipients. The pooled incidence rate of SCD was 1.30 per 100 person-years (95% CI: 1.08-1.52). Cardiac allograft vasculopathy (CAV) was associated with higher SCD risk (2.40 per 100 patient-years, 95% CI: 1.46-3.34). Independent predictors of SCD identified by two moderate-quality studies were older donor age, younger recipient age, non-Caucasian race, reduced left ventricular ejection fraction, rejection, infection, and cancer. Authors rarely reported on ICD use. Conclusion: This meta-analysis found that post-transplant SCD risk in heart transplant recipients is higher than that in the general population. CAV was associated with increased SCD risk. Observational studies reporting on absolute risk of SCD are needed to better identify populations at a clinically significant increased risk.

Original languageEnglish (US)
Article numbere13206
JournalClinical Transplantation
Volume32
Issue number3
DOIs
StatePublished - Mar 2018
Externally publishedYes

Keywords

  • heart transplant
  • meta-analysis
  • patient survival
  • risk assessment
  • risk stratification
  • sudden cardiac death

ASJC Scopus subject areas

  • Transplantation

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