Lung Transplantation from Donors with a History of Substance Use

Abstract

<h3>Purpose</h3> Substance use is common among lung transplant donors, but the implications have not been well studied aside from donor smoking. Stimulant drugs such as cocaine and methamphetamine can induce pulmonary arterial hypertension while smoked products such as cannabis and crack cocaine can produce airways and parenchymal lung diseases. We sought to characterize donor substance use at our center and evaluate the associations with overall survival as well as post-transplant graft function. <h3>Methods</h3> We studied all double lung transplants in our program between 2004-2016. We reviewed donor substance use histories for the following: heavy smoking, heavy drinking, regular cannabis smoking, ecstasy, benzodiazepines, cocaine, crack cocaine, methamphetamine, crystal methamphetamine, and opiates. We used proportional hazards modelling to evaluate the association between each drug and overall survival as well as chronic lung allograft dysfunction (CLAD) development. We used Fisher's Exact test to evaluate the association between drug use and grade 3 primary graft dysfunction (PGD3) in addition to baseline lung allograft dysfunction (BLAD), defined as failure to achieve both FEV1 and FVC ≥80% predicted on 2 consecutive tests ≥3 weeks apart. <h3>Results</h3> Of 473 recipients studied, 186 (39%) received lungs from a donor with a history of drug use in at least one of the 9 categories defined previously. Donor heavy smoking (n=65) was associated with lower overall survival (hazard ratio [HR]: 1.47; 95% confidence interval [CI]: 1.03-2.10; p=0.032) and an increased risk of PGD3 (odds ratio [OR]: 2.13; 95% CI: 1.15-3.84; p=0.014) and BLAD (OR: 2.56; 95% CI: 1.47-4.53; p<0.001). Donor crack cocaine use (n=24) was also associated with impaired overall survival both unadjusted (HR: 2.02; 95% CI: 1.15-3.55; p=0.015) and adjusted for donor heavy smoking (HR: 1.99; 95% CI: 1.13-3.50; p=0.017). No other history of donor substance use was associated with post-transplant survival, CLAD, PGD3, or BLAD. <h3>Conclusion</h3> History of substance use was common in our cohort of lung donors. Donor crack cocaine use in addition to donor heavy smoking were associated with impaired post-transplant survival while donor use of other substances does not appear to affect survival and lung function outcomes post-transplant.