Heart Failure and Transplantation Program, Toronto General Hospital, University Health Network, Toronto, Ontario, Canada.
Labatt Family Heart Centre, Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.
Clin Transplant. 2019 Mar;33(3):e13490. doi: 10.1111/ctr.13490. Epub 2019 Feb 18.
Sudden cardiac death (SCD) is responsible for ~10% of post-heart transplant deaths. We conducted a retrospective analysis of the ISHLT registry evaluating the risk of post-transplant SCD. Adult heart transplant recipients (2004-2014) surviving the first year were included. We used multivariable multistate competing risk survival analysis to evaluate the impact of history of treated rejection and cardiac allograft vasculopathy (CAV) on SCD risk. We used a probabilistic analytical model and Monte Carlo simulation to estimate the impact of CAV severity and graft dysfunction on SCD. We included 25 242 recipients. During a median follow-up of 4.7 (2.3-7.0) years, 582 patients died suddenly. Treated rejection (HR 1.76, 95% CI 1.36-2.31) and CAV (HR 3.32, 95% CI 2.73-4.03) were important risk factors for SCD. The estimated SCD risk in patients with severe CAV without and with graft dysfunction was 3.2% (95% CI 2.0-4.6) and 5.4% (95% CI 3.8-7.0), respectively, at 2 years from the CAV diagnosis, and 4.9% (95% CI 3.4-6.5) and 8.0% (95% CI 6.1-10.0), respectively, in those who also had treated rejection. These results provide evidence that recipients with severe CAV and graft dysfunction or treated rejection are at clinically significant increased SCD risk. The benefit of ICD post-transplant remains uncertain.
心脏移植后，心源性猝死（SCD）是导致 10%左右患者死亡的主要原因。我们对国际心肺移植协会（ISHLT）注册数据库进行了回顾性分析，旨在评估心脏移植后 SCD 的发病风险。研究纳入了 2004 年至 2014 年期间心脏移植术后存活满一年的成年患者。采用多变量多状态竞争风险生存分析评估治疗性排斥反应和心脏移植物血管病（CAV）病史对 SCD 风险的影响。采用概率分析模型和蒙特卡罗模拟来评估 CAV 严重程度和移植物功能障碍对 SCD 的影响。我们共纳入了 25242 例患者，中位随访时间为 4.7 年（2.3-7.0 年），582 例患者发生猝死。治疗性排斥反应（HR 1.76，95%CI 1.36-2.31）和 CAV（HR 3.32，95%CI 2.73-4.03）是 SCD 的重要危险因素。无和伴有移植物功能障碍的严重 CAV 患者在 CAV 确诊后 2 年发生 SCD 的风险估计分别为 3.2%（95%CI 2.0-4.6）和 5.4%（95%CI 3.8-7.0），同时合并治疗性排斥反应的患者 SCD 风险估计分别为 4.9%（95%CI 3.4-6.5）和 8.0%（95%CI 6.1-10.0）。这些结果为严重 CAV 伴有或不伴有移植物功能障碍或治疗性排斥反应的患者 SCD 风险显著增加提供了证据。心脏移植后植入式心律转复除颤器（ICD）的获益仍不确定。
