Key result
Pre-transplant implantable cardioverter-defibrillator status was not associated with a change in long-term survival post-heart transplantation (HR 0.98; 95% CI 0.90-1.07).
Why the study?
Sudden cardiac death affects 8%-35% of patients post-heart transplantation, but it was unknown whether pre-transplant ICD risk stratification associates with post-transplant outcomes.
Does pre-transplant ICD status affect long-term survival in adult heart transplant recipients?
Cohort (n=19,026)
Yes
Does pre-transplant ICD status affect long-term survival in adult heart transplant recipients?
Hazard Ratio: 0.98 (95% CI 0.9–1.07)
Pre-transplant ICD status does not impact long-term survival following heart transplantation, despite these patients having a higher baseline risk profile.
Pre-transplant ICD status should not guide post-transplant prognosis; leaves open optimal device strategies in advanced HF.
BACKGROUND: Sudden cardiac death (SCD) post-heart transplantation affects 8%-35% of patients; however, the risk profile remains to be completely elucidated. While pre-transplant ICDs are typically removed during transplantation, no information exists to suggest if this pre-transplant risk stratification is also associated with post-transplant outcomes. The objective of this study was to assess the impact of pre-transplant ICD status on long-term prognosis post-heart transplant. METHODS: The United Network for Organ Sharing registry was queried for all adult heart transplant recipients from 2010 to 2018. Patients were categorized as with versus without ICD prior to heart transplantation. Survival was compared using Kaplan-Meier analysis. Proportional hazards regression analysis assessed the impact of ICDs adjusting for clinical and demographic covariates. RESULTS: Of 19 026 patients included, 78.6% (n = 14 960) had received an ICD at time of registration. Patients with an ICD were older [54.9 (±11.6) years vs. 48.6 (±15.3) years, p < .001], less likely to be female [25.7% (n = 3842) vs. 31.2% (n = 1269), p < .001], and more commonly diabetic [29.3% (n = 4376) vs 23.5% (n = 954), p < .001]. Kaplan-Meier analysis showed no difference in unadjusted survival trajectory by ICD status (chi-square = .48, p = .49). Survival was unrelated to ICD status in the multivariable model (HR = .98; 95% CI .90-1.07). CONCLUSIONS: Patients receiving an ICD pre-transplant had a higher prevalence of risk factors for SCD than non-ICD patients, yet ICD status prior to heart transplantation was not associated with a change in long-term prognosis post-heart transplantation.
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Dean et al. (2022) conducted a cohort in Heart transplant (n=19,026). Pre-transplant implantable cardioverter-defibrillator (ICD) vs. No pre-transplant ICD was evaluated on Long-term survival (HR 0.98, 95% CI 0.90-1.07). Pre-transplant implantable cardioverter-defibrillator status was not associated with a change in long-term survival post-heart transplantation (HR 0.98; 95% CI 0.90-1.07).
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