Cocaine use in organ donors and long-term outcome after heart transplantation: An International Society for Heart and Lung Transplantation registry analysis

Vieira, Jefferson L.; Cherikh, Wida S.; Lindblad, Kelsi; Stehlik, Josef; Mehra, Mandeep R.

doi:10.1016/j.healun.2020.08.018

Cited by 12 publications

(11 citation statements)

References 29 publications

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“…Recurrent ACR grade 1R is associated with CAV-and cardiovascular-related mortality after HTx [117]. Factors not associated with increased CAV include donor history of cocaine use, donor ischemic time, and post-HTx AMR ≥pathologic grade 1 during first year or PGD, irrespective of severity [3,43,86,123,124]. Donorderived CAD does not seem to accelerate progression of CAV [50].…”

Section: Cardiac Allograft Vasculopathymentioning

confidence: 96%

“…Recipients who undergo HTx for idiopathic dilated cardiomyopathy have lower 1-year mortality [25], while those with ischemic cardiomyopathy have higher long-term mortality post-HTx [29]. Other preoperative recipient risk factors associated with worse survival after HTx include pulmonary arterial hypertension [34,35], renal dysfunction [26,27,[36][37][38][39], prior sternotomy [40][41][42], prolonged ventilator support or intensive care unit (ICU) stay [25][26][27]36,43,44], and MCS use [25,27,36,37,39,43]. In recipients with pre-HTx MCS use, allograft dysfunction has not been associated with pre-HTx device-related complications [45].…”

Section: Recipient Risk Factorsmentioning

confidence: 99%

“…The number of donors with history of cocaine use increased from 11% in 2000 to 27% in 2018, along with the number of donors with history of non-intravenous non-prescription street drug use which has doubled from 25% to 57% [46]. Notably, there is no difference in short-and long-term survival outcomes between recipients of donors with and without history of cocaine use [27,43]. Multiple studies, including single-center and registry reports, have showed similar survival between recipients of high-risk donors and of standard risk donors at 1 year (84.3% vs. 83%) and 5 years (71.2% vs. 65.5%) post HTx [56,57].…”

Section: Cardiopulmonary Resuscitation and High-risk Donorsmentioning

confidence: 99%

“…Risk factors associated with developing rejection include female donor gender, recipient elevated BMI, and recurrent ACR grade 1R [24,36,116,117]. Factors not associated with increased rejection episodes include donor CPR status or history of cocaine use, and recipient history of prior sternotomy or prior MCS use (durable or temporary) [9,40,43,54]. Donor ischemic time does not seem to affect rejection-related mortality after HTx [52].…”

Section: Rejection Of Allograftmentioning

confidence: 99%

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Current status and outcomes in heart transplantation: a narrative review

Awad¹,

Shah²,

Griffith³

2022

Rev. Cardiovasc. Med.

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The first human heart transplantation was performed by Christian Barnard in 1967. While the technical aspect had been worked out, allograft rejection was a major limitation in the early days of heart transplant. The discovery of cyclosporine revolutionized the field and led to the modern era of transplant. Heart transplantation now offers the best survival benefit for patients with end-stage heart failure with a median survival over 12 years. However, there are still limitations including the impact of limited availability of graft, graft dysfunction, and rejection, and long-term non-cardiac complications. This review serves as an update on the short-and long-term outcomes following heart transplantation focusing on the new donor allocation system, efforts to expand the donor pool, primary graft dysfunction, acute cellular and antibody-mediated rejection, cardiac allograft vasculopathy, and post-transplant malignancy and renal dysfunction.

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Section: Cardiac Allograft Vasculopathymentioning

confidence: 96%

Section: Recipient Risk Factorsmentioning

confidence: 99%

Section: Cardiopulmonary Resuscitation and High-risk Donorsmentioning

confidence: 99%

Section: Rejection Of Allograftmentioning

confidence: 99%

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Current status and outcomes in heart transplantation: a narrative review

Awad¹,

Shah²,

Griffith³

2022

Rev. Cardiovasc. Med.

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“…Previous reports on drug use in donors and the effect on outcomes have all been based on history. 10 , 11 This information is recorded via several yes/no variables in the United Network for Organ Sharing (UNOS) registry database. Recently, data utilizing the donor toxicology results and historical variables were published, showing that survival was similar regardless of drug use (historical or toxicological evidence).…”

mentioning

confidence: 99%

Donor Utilization in the Recent Era: Effect of Sex, Drugs, and Increased Risk

Baran

Long

Lansinger

et al. 2022

Circ: Heart Failure

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Background: Heart transplantation volumes have increased in recent years, yet less than a third of donors are typically accepted for transplantation. Whether donor sex, donor drug use, or perception of increased risk affects utilization for transplantation is unclear. Methods: The United Network for Organ Sharing database was queried for donors from January 1, 2007, to December 31, 2017. Donor toxicology was collected when available. Multivariate analysis was conducted to examine correlations with donor utilization. Results: Between January 1, 2007, and December 31, 2017, there were 87 816 heart donors aged ≥15 years. The mean age was 42.7±15.8 years, and 24 831 donors (28.3%) were utilized for heart transplantation. Subsequent analyses focused on donors between 15 and 39 years old. The strongest associations with donor acceptance were for male donor sex, blood type, hepatitis C antibody, donor age, left ventricular hypertrophy, and history of donor drug use. After removing hepatitis C, Public Health Service Increased Risk was identified as a strong negative predictor. Most positive drug toxicology results were associated with donor nonuse except for donors between 15 and 19 years of age. Exceptions included alcohol, marijuana, and cocaine. Opiates were associated with less utilization at all donor ages. The Public Health Service Increased Risk status was associated with significantly less utilization in all age groups except 15- to 19-year-old donors. Conclusions: While male donors were preferentially utilized, donors with drug use or those deemed Public Health Service Increased Risk were significantly less utilized for heart transplantation. Further consideration of such donors would be appropriate particularly as the demand for transplantation continues to increase.

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