Implantable Cardioverter-Defibrillators in Heart Transplant Recipients with Allograft Failure

Abstract

Purpose Sudden cardiac death may occur in the setting of acute rejection or later in patients with allograft vasculopathy. The role of implantable cardioverter-defibrillators (ICDs) in heart transplant recipients with allograft failure is unknown. Methods We analyzed the United Network for Organ Sharing registry between January 2008 and March 2018 to include adults ≥18 who had undergone heart transplantation and were listed for retransplantation for the indication of allograft failure. Results Between January 2008 and March 2018, 1201 heart transplant recipients were re-listed for transplant of whom 229 (19%) had an ICD. Indications for re-listing included coronary artery disease (n = 699, 58%), primary graft failure (n = 188, 15.7%), chronic rejection (n = 141, 11.7%), acute rejection (n = 60, 5.0%), non-specific reason (n = 57, 4.7%), restrictive or constrictive disease (n = 49, 4.1%), and hyperacute rejection (n = 7, 0.6%). Allograft failure patients with ICDs were younger than those without (47.3 vs 43.5 years, p Conclusion Approximately 1 in 5 heart transplant recipients re-listed for primary allograft failure received an ICD. The use of ICDs does not appear to be associated with increased waitlist survival. More research is needed regarding the role of ICDs in this unique population.