The Real Story About Drug Abuse Donor Hearts After Heart Transplant.

Abstract

Background: Many centers will not consider a donor heart (ht) if there is a history of donor drug abuse, including heroin, cocaine, methamphetamine, and marijuana. There has been concern regarding the quality of these hts and whether there is underlying damage that may affect outcome after heart transplant (HTx). We sought to address this concern by evaluating our patients (pts) who received a drug abuse donor ht. Methods: Between 2007 and 2012 we reviewed 65 HTx pts whose donor had a history of drug abuse. Pts who had drug abuse donors were divided into donors with heroin, cocaine, methamphetamine, and marijuana abuse. These pts were compared to 180 pts whose donors did not have drug abuse history. Post-operative endpoints were initial intubation time, post-HTx ICU stay, 1-year (yr) freedom from any treated rejection on infection, 3-yr actuarial survival, 3-yr freedom from cardiac allograft vasculopathy (CAV) and non-fatal major cardiac events (NF-MACE: myocardial mnfarction, congestive heart failure, angioplasty, pacemaker/ICD, stroke). Results: We identified 65 pts whose donors had drug abuse history, including: 10 pts with heroin abuse, 14 pts with cocaine abuse, 23 pts with methamphetamine abuse and 46 pts with marijuana abuse. Pts may have a history of multiple drug abuse. 47 of the 65 (72.3%) pts were transplanted as status 1. Among the drug abuse history donor ht pts, there was no significant difference in intubation time, post-HTx ICU stay compared to pts whose donors did not have drug abuse history. Furthermore, there is no significant difference in 1-yr and 3-yr post-HTx outcomes (see table).Table: No Caption available.Conclusion: Pts who received donor hts with a history of drug abuse appear to have acceptable outcomes after HTx. These donor hts should be considered for HTx. DISCLOSURES:Patel, J.: Grant/Research Support, Alexion Pharmaceuticals. Chang, D.: Stockholder, Abbott Pharmaceuticals. Esmailian, F.: Grant/Research Support, Transmedics, Inc. Kobashigawa, J.: Grant/Research Support, XDx, Inc., Novartis Pharmaceuticals, Transmedics, Inc.