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

PurposeSudden cardiac death (SCD) is an important post-transplant problem being responsible for similar to 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). MethodsCitations 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. ResultsThis study includes 55 studies encompassing 47901 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. ConclusionThis 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.