Primary Graft Dysfunction and Early Mortality in Heart Transplants from Drug Overdose Donors

Abstract

Introduction Over the last two decades, there has been a 24-fold rise in solid organ donation due to drug overdose deaths. One-year survival in recipients of a heart transplant from a drug overdose donor (DOD) has been reported to be similar to that of donor deaths from trauma or other medical causes (non-DOD). However, the incidence of primary graft dysfunction (PGD) requiring mechanical circulatory support (MCS) and early post-transplant mortality in these patients has not been established. Hypothesis Heart donation from a DOD results in higher rates of PGD and early post-transplant mortality than donation from a non-DOD. Methods We performed a retrospective analysis of consecutive orthotopic heart transplants (OHT) at a single center from January 2013 to December 2018. Patients with PGD requiring MCS in the form of extracorporeal membrane oxygenation (ECMO) within 48 hours of OHT were analyzed with respect to the cause of death of the donor. Patients on ECMO prior to transplant surgery were excluded. Baseline characteristics were compared using Chi-square test for categorical variables and t-test for continuous variables. Results Of 154 consecutive heart transplants, 5 were excluded due to pre-operative recipient ECMO support. Among the 149 analyzed transplants, 38 (25.5%) received a heart from a DOD. DOD had a lower initial pH (7.15 vs. 7.28, p=0.001), a higher rate of hepatitis C infection (15.8% vs. 1.8%, p=0.001) and were more likely to have received CPR (91.7% vs.32%, p Conclusions In this single-center study, there was a trend towards an increased risk of PGD when the donor had died from a drug overdose, possibly due to ischemic graft injury related to hypoxia. However, survival to hospital discharge was similar between the DOD and non-DOD groups. Given the rapid increase in the number of DODs, further investigation in larger populations is warranted as it may help inform donor selection.