Cocaine Use in Organ Donors and Long-Term Outcome after Heart Transplantation: An ISHLT Registry Analysis

Abstract

Organs from donors exposed to cocaine are often discarded due to quality concerns related to vascular spasm, myocardial ischemia and inflammation that may influence outcomes after heart transplantation (HTx). We investigated long-term outcomes of de-novo adult HTx using donors with a current or prior history of cocaine use. Using the ISHLT Thoracic Organ Transplant Registry, we conducted a retrospective cohort study with outcomes of interest including development of cardiac allograft vasculopathy (CAV) or treated acute rejection (AR) within 5 years and survival at 10 years after HTx. The evaluable cohort included 24,430 adult recipients with primary HTx alone, between January 1, 2000 and June 30, 2013. Transplants were categorized into "non-user" (donors with no history of cocaine use, N=21,184) or "any exposure" (donors with any history of cocaine use, N=3,246). Organs from "any exposure" were transplanted at a higher sequence number than those from "non-user" (mean 16.1±55.6 vs 11.5±38.2; median 3 [IQR 1-11] vs 3 [IQR 1-8]; P<0.001) suggesting higher initial discard rates by centers. The unadjusted rate of CAV was marginally higher in recipients with "any exposure" donors compared to "non-user" donors (26% vs. 24%; P=0.027), as was the unadjusted actuarial freedom from CAV (log-rank test, P=0.037, Figure 1A). After multivariate adjustment with variables significantly associated with development of CAV, there was no association between donor cocaine use and development of CAV at 5 years (HR, 1.02; 95% CI, 0.94-1.11; P=0.56). There was no significant difference in unadjusted rate of AR at 5 years (Figure 1B) and patient survival at 10 years (Figure 1C) by donor cocaine use. Our findings suggest that in well selected donor-recipient pairs, adult HTx performed using donors with a history of cocaine use does not adversely influence long-term clinical outcomes. These findings should spur efforts to reduce rates of discard of organs from cocaine exposed donors.