Outcomes of Heart Transplant from Donors with a History of Heavy Alcohol Use: Don't Throw the Baby Out with the Bathtub Gin

Abstract

<h3>Purpose</h3> Donors with a history of heavy alcohol use (DHAU) may have subclinical cardiomyopathy, resulting in poor outcomes after heart transplantation (HT). We sought to assess short-and long-term mortality, graft failure and cardiac allograft vasculopathy (CAV) in HT recipients from DHAU. <h3>Methods</h3> The cohort included adult primary transplants between 2008 and 2017 from the ISHLT TTX registry. Between-group differences were evaluated by Wilcoxon-rank sum tests and Fisher's exact tests for continuous and dichotomous/polytomous variables, respectively. The freedom from death was characterized using the Kaplan-Meier survival methods with log-rank tests; Cox proportional hazard regression was used to quantify of DHAU. The incidence rate of CAV was characterized using a competing risk model with Gray's tests, and the association of DHAU was assessed using cause-specific hazard regression. <h3>Results</h3> A total of 21,744 HT recipients were included, of which, 3,523 were classified as DHAU. The median (IQR) follow-up time was 3.8 (1.8 - 6.2) years. Among DHAU, there was a higher proportion of heavy smokers (32% <i>vs</i>. 11%, <i>p</i><0.001), cocaine use (35% <i>vs</i>. 14%, <i>p</i><0.001) and a higher proportion of angiograms completed (49% <i>vs</i>. 23%, <i>p</i><0.001). When stratified by DHAU, 1-year graft failure (<i>p</i>= 0.76) and 5-year survival were similar (<i>p</i>=0.25). The proportion of recipients experiencing CAV within 5 years and 10 years was significantly higher in recipients with DHAU (HR [95% CI] = 1.30 [1.20, 1.42], <i>p</i>< 0.001) (Figure 1). When adjusted for covariates, these recipients from DHAU were more likely to experience CAV (HR [95% CI] = 1.17 [1.07, 1.27], p< 0.001) within 5-years of HT (Table 1). <h3>Conclusion</h3> A donor history of heavy alcohol use was not a risk factor for poor short-term outcomes; however, DHAU are associated with an increased risk of developing CAV. Recipients of such donors may benefit from more intensive monitoring and earlier initiation of CAV related therapies.