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

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 Citati...

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Bibliographic Details
Published in:Clinical transplantation 2018-03, Vol.32 (3), p.e13206-n/a
Main Authors: Alba, Ana C., Foroutan, Farid, Ng Fat Hing, Nicholas Kwet Vong, Fan, Chun‐Po S., Manlhiot, Cedric, Ross, Heather J.
Format: Article
Language:English
Subjects:
Canada - epidemiology
Death, Sudden, Cardiac - epidemiology
Death, Sudden, Cardiac - etiology
Death, Sudden, Cardiac - pathology
Heart Failure - surgery
heart transplant
Heart Transplantation - adverse effects
Humans
Incidence
meta‐analysis
patient survival
Prognosis
risk assessment
Risk Factors
risk stratification
sudden cardiac death
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Summary: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.
ISSN:0902-0063
1399-0012
DOI:10.1111/ctr.13206