Sudden death after heart transplantation: the major mode of death.

The mode of death, specifically sudden cardiac death (SCD), after heart transplantation has not been well characterized. It is known that rejection, infection and cardiac allograft vasculopathy (CAV) are the major disease processes that result in death after cardiac transplantation. To characterize SCD in this setting, we reviewed 532 adult heart transplant patients who survived initial hospitalization between 1990 and 1999. In these 532 patients, there were 139 deaths: 80 (58%) classified as SCD (defined as witnessed sudden unexpected death at home, witnessed sudden death in hospital, or sudden death at an outside hospital); of the remaining 59 deaths, 27 (19%) were expected deaths, and there were 32 (23%) deaths with insufficient data for classification. The underlying diseases in these 80 SCD patients are shown in the table. Severe CAV (all three vessels involved) was the greatest risk for sudden death.