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Updated: Nov 28, 2025
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Published on: July 1, 2012
Sudden cardiac death following liver transplantation: Incidence, trends and risk predictors
Anoop N Koshy1, Paul J Gow2, Hui-Chen Han1
1Department of Cardiology, Austin Health, Melbourne, Victoria, Australia; Department of Medicine, The University of Melbourne, Victoria, Australia.
Insights
Sudden cardiac death (SCD) is the primary cause of cardiovascular mortality after liver transplantation (LT). Pre-transplant diabetes significantly increases SCD risk, necessitating targeted therapies for at-risk patients.
Area of Science:
- Cardiology
- Transplant Surgery
- Public Health
Background:
- Cardiovascular events are a major cause of death post-liver transplantation (LT).
- Sudden cardiac death (SCD) is a significant concern, but data on its incidence and predictors are limited.
- Understanding SCD risk factors is crucial for improving post-transplant outcomes.
Purpose of the Study:
- To determine the incidence and predictors of SCD following LT.
- To analyze temporal trends in SCD risk after liver transplantation.
- To identify patient characteristics associated with increased SCD risk.
Main Methods:
- A cohort study utilized data from the Australian and New Zealand Liver Transplant Registry (1985-2017).
- Included 4265 adult LT recipients followed for 37,409 person-years.
- Causes of death were adjudicated by an interdisciplinary panel.
Main Results:
- SCD was the leading cause of cardiovascular death post-LT, with an incidence rate of 165 per 100,000 person-years.
- SCD risk increased significantly in the contemporary era (1996-2017) compared to the early era (1985-1995).
- Pre-transplant diabetes was the sole independent predictor of SCD (HR 2.5).
Conclusions:
- SCD is the primary cause of cardiovascular mortality after LT.
- Patients with pre-transplant diabetes have a doubled risk of SCD.
- Targeted interventions for LT candidates with diabetes are essential to reduce post-transplant SCD risk.
Background:
Cardiovascular events are a leading cause of mortality following liver transplantation (LT). Although a preponderance of sudden cardiac death (SCD) in this population has been reported, there is a paucity of data evaluating the incidence, timing and predictors of SCD following LT.
Methods:
Using the prospectively collected Australian and New Zealand Liver Transplant Registry, a cohort study of all adult LTs from 1985 to 2017 was performed to ascertain the incidence and predictors of SCD. Recipient cause of death was adjudicated by an interdisciplinary panel.
Results:
4265 LT patients were followed-up for 37,409 person-years. SCD was the leading mode of cardiovascular death with an incidence rate of 165 per 100,000 person-years. There was a significant increase in the hazard of SCD in the contemporary (1996-2017) vs early era (1985-1995) (hazard ratio [HR] 2.42, 95%CI 1.10-5.40; p = 0.02). On Cox regression after adjusting for significant univariate predictors including age, coronary artery disease and non-alcoholic steatohepatitis, pre-transplant diabetes was the only independent predictor of SCD (HR 2.5 95%CI 1.1-6.0).
Conclusion:
SCD is the leading mode of cardiovascular cause-specific mortality following LT and diabetes was associated with a two-fold higher risk for its occurrence. Given the escalating cardiovascular risk factor profile of LT candidates, targeted therapies especially in patients with diabetes are needed to mitigate risk of post-transplant SCD.
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