Sudden cardiac death after heart transplantation: a population-based study

Area of Science:

• Cardiology
• Transplantation Medicine
• Epidemiology

Background:

• Sudden cardiac death (SCD) epidemiology post-heart transplantation (HTx) is not well-defined.
• Assessing SCD incidence and risk factors in HTx recipients is critical for improving patient outcomes.

Purpose of the Study:

• To determine the incidence and identify determinants of SCD in a large cohort of heart transplant recipients.
• To compare SCD risk in HTx recipients against the general population.

Main Methods:

• A cohort of 1246 heart transplant recipients transplanted between 2004-2016 was prospectively followed.
• Clinical, biological, pathological, and functional parameters were assessed, with SCD centrally adjudicated.
• Competing risk multivariate Cox models were used to identify independent predictors of SCD.

Main Results:

• The annual incidence of SCD was 12.5 per 1,000 person-years in HTx recipients versus 0.54 in the general population.
• SCD risk was substantially elevated in younger HTx recipients (SMR up to 837 for ≤30 years).
• Independent predictors of SCD included older donor age, younger recipient age, recipient ethnicity, pre-existing donor-specific antibodies, and last ejection fraction.

Conclusions:

• Heart transplant recipients face a very high risk of SCD, particularly younger individuals.
• SCD is the leading cause of death beyond the first year post-transplant in this cohort.
• Identifying specific risk factors can aid in stratifying risk and managing high-risk subgroups.