Association between increased‐risk donor social behaviors and recipient outcomes after heart transplantation

Okoh, Alexis K.; Chan, Olivia; Schultheis, Molly; Gupta, Mitalie; Shah, Aakash; Gold, Justin; Russo, Mark J.; Lee, Leonard Y.; Camacho, M.

doi:10.1111/ctr.13787

Cited by 7 publications

(15 citation statements)

References 11 publications

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“… 16 Recent publications support this and none show a difference in outcome with chronic alcohol use. 12 , 13 , 28 The current study also supports the safety of such donors and should alleviate concerns about using hearts from donors with a history of significant alcohol use.…”

Section: Discussionsupporting

confidence: 67%

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Intoxicated Donors and Heart Transplant Outcomes: Long-Term Safety

Baran

Lansinger

Long

et al. 2021

Circ: Heart Failure

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Background: The opioid crisis has led to an increase in available donor hearts, although questions remain about the long-term outcomes associated with the use of these organs. Prior studies have relied on historical information without examining the toxicology results at the time of organ offer. The objectives of this study were to examine the long-term survival of heart transplants in the recent era, stratified by results of toxicological testing at the time of organ offer as well as comparing the toxicology at the time of donation with variables based on reported history. Methods: The United Network for Organ Sharing database was requested as well as the donor toxicology field. Between 2007 and 2017, 23 748 adult heart transplants were performed. United Network for Organ Sharing historical variables formed a United Network for Organ Sharing Toxicology Score and the measured toxicology results formed a Measured Toxicology Score. Survival was examined by the United Network for Organ Sharing Toxicology Score and Measured Toxicology Score, as well as Cox proportional hazards models incorporating a variety of risk factors. Results: The number and percent of donors with drug use has significantly increased over the study period ( P <0.0001). Cox proportional hazards modeling of survival including toxicological and historical data did not demonstrate differences in post-transplant mortality. Combinations of drugs identified by toxicology were not associated with differences in survival. Lower donor age and ischemic time were significantly positively associated with survival ( P <0.0001). Conclusions: Among donors accepted for transplantation, neither history nor toxicological evidence of drug use was associated with significant differences in survival. Increasing use of such donors may help alleviate the chronic donor shortage.

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Section: Discussionsupporting

confidence: 67%

“…Recent studies have looked at the UNOS cause of death field and have found that drug intoxication donor cause of death is not associated with adverse post-transplant outcomes. 10 , 13 …”

Section: Discussionmentioning

confidence: 99%

Intoxicated Donors and Heart Transplant Outcomes: Long-Term Safety

Baran

Lansinger

Long

et al. 2021

Circ: Heart Failure

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“…A study by Okoh et al. has even shown that recipients of IRD hearts do not differ in 5‐year post‐transplant survival compared to recipients of non‐IRD hearts 26 . A primary concern for IRD organs is the transmission of HCV.…”

Section: Discussionmentioning

confidence: 99%

“…has even shown that recipients of IRD hearts do not differ in 5-year post-transplant survival compared to recipients of non-IRD hearts. 26 A primary concern for IRD organs is the transmission of HCV. This study included two HCV positive heart DTD donors, both were NAT negative (unlikely to transmit infection) and did not transmit HCV to their respective recipients.…”

Section: Discussionmentioning

confidence: 99%

Outcomes following heart or bilateral‐lung transplantation from donors who died of drug toxicity in British Columbia, Canada

Xie

Keenan

Toma

et al. 2022

Clinical Transplantation

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Introduction:The illicit drug toxicity (overdose) crisis has worsened across Canada; between 2016 and 2021, more than 28,000 individuals have died of drug toxicity.Organ donation from persons who experience drug toxicity death (DTD) has increased in recent years. This study examines whether survival after heart or bilateral-lung transplantation differed by donor cause of death. Methods: We studied transplant recipients in British Columbia who received heart (N = 110) or bilateral-lung (N = 223) transplantation from deceased donors aged 12-70 years between 2013 and 2019. Transplant recipient survival was compared by donor cause of death from drug toxicity or other. Five-year Kaplan-Meier estimates of survival and 3-year inverse probability treatment weighted Cox proportional hazards models were conducted.Results: DTD donors made up 36% (40/110) of heart and 24% (54/223) of bilaterallung transplantations. DTD donors were more likely to be young, white, and male.Unadjusted 5-year recipient survival was similar by donor cause of death (heart: 87% for DTD and 86% for non-DTD, p = .75; bilateral-lung: 80% for DTD and 76% for non-DTD, p = .65). Adjusted risk of mortality at 3-years post-transplant was similar between recipients of DTD and non-DTD donor heart (hazard ratio [HR]: .94, 95% con-

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“…This is despite evidence that the objective risk of transmission is extremely low ( 5 – 7 ), and that IVRD organs come from donors who are on average younger, and have less comorbidities ( 8 , 9 ). Recipients who accept an IVRD organ offer, have fewer post-transplant complications, and in some series, improved long-term survival ( 10 – 13 ).…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Blood-Borne Viruses and Predictors of Risk in Potential Organ Donors in Australia

Dutch

Patrick²,

Boan

et al. 2022

Transpl Int

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Internationally, the designation of a patient as an increased viral risk organ donor has been associated with lower utilisation rates. The actual prevalence of blood borne viruses in Australian potential organ donors, and the predictive performance of questionnaires administered to stratify this risk, remains unknown. We conducted a retrospective review of all patients who commenced workup for donation on the national database between 2014–2020. The prevalence of HIV, Active HBV and Active HCV in 3650 potential organ donors was 0.16%, 0.9%, and 2.2%, respectively. The behavioural risk profile was assessed in a subset of 3633 patients. Next-of-kin reported increased risk behaviours were associated with an increased prevalence of HCV but not of HIV or HBV (OR 13.8, p < 0.01, OR 0.3. p = 0.42, OR 1.5, p = 0.14). Furthermore, the majority of HIV and HBV infections occurred in potential donors without a disclosed history of increased risk behaviours. In this series, donors had a higher prevalence of HCV, and similar rates of HBV and HIV to the broader community. Behavioural transmission risks were poorly predictive of HIV and HBV. Rather than pre-transplantation behavioural risk screening, routine post-transplant recipient screening may provide a more powerful tool in mitigating the consequences of unexpected viral transmission.

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Association between increased‐risk donor social behaviors and recipient outcomes after heart transplantation

Cited by 7 publications

References 11 publications

Intoxicated Donors and Heart Transplant Outcomes: Long-Term Safety

Intoxicated Donors and Heart Transplant Outcomes: Long-Term Safety

Outcomes following heart or bilateral‐lung transplantation from donors who died of drug toxicity in British Columbia, Canada

Prevalence of Blood-Borne Viruses and Predictors of Risk in Potential Organ Donors in Australia

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