U. Nasim1, Y. Hong1,2, N. Iyanna2, A. Dorken Gallastegi1, J. Bonatti2, P. Yoon2, D. Chu2, D. Serna-Gallegos2, I. Sultan2, D.J. Kaczorowski2 1University Of Pittsburgh Medical Center, Surgery, Pittsburgh, PA, USA 2University Of Pittsburgh Medical Center, Cardiothoracic Surgery, Pittsburgh, PA, USA
Introduction: Donation after circulatory death (DCD) heart transplantation is expanding rapidly in the United States, but there is insufficient clinical evidence guiding donor selection and appropriate risk stratification. Donors with a history of cocaine use are utilized in donation after brain death (DBD) heart transplantation following structural and angiographic examination. However, the mandatory ischemic period in DCD heart procurement may result in additional injury when utilizing these donor hearts. In this study, we evaluated the impact of recent donor cocaine use on recipient outcomes following DCD heart transplantation in the United States.
Methods: The UNOS database was used to analyze adult heart transplant recipients between 1/1/2019 and 6/1/2023. DBD, multi-visceral, and heterotopic heart transplantation were excluded from the analysis. The recipients were stratified into two groups based on recent donor cocaine use. Recent cocaine use was defined as within 6 months from the time of donation. Baseline recipient, donor, and transplant characteristics were compared between the two groups. The primary outcomes were 1-year post-transplant survival and the rates of renal failure requiring dialysis, stroke, permanent pacemaker implantation, hospital length of stay, and treated acute rejection.
Results: Of the 743 recipients analyzed, 136 (18.3%) received hearts from donors with recent cocaine use. The proportion of DCD heart transplants involving donors with recent cocaine use increased from 14% in 2020 to 20% in 2023. Donors with recent cocaine use had a greater frequency of drug overdose death (14.8% vs. 58.1%, p<0.001), hepatitis C (5.9% vs. 18.4%; p=0.002), and impaired (<50%) ejection fraction (0.7% vs. 5.1%; p<0.001) compared to the donors without cocaine use. Recipient and transplant characteristics were otherwise similar between the two groups. The 1-year post-transplant survival was comparable between the two groups (91.6% vs. 91.8%, p=0.757; Figure). Furthermore, post-transplant complications during index hospitalization were also similar. Moreover, no difference in post-transplant survival was observed when comparing DBD and DCD heart transplantation from recent cocaine use donors (92.0% vs. 91.3%; p=0.735).
Conclusion: Cocaine use within 6 months of donation is prevalent among donors in DCD heart transplantation. Donor cocaine use does not adversely impact outcomes following DCD heart transplantation in carefully selected cases. Furthermore, hearts from donors with cocaine use can be safely used in both DBD and DCD heart transplantation. Future studies are necessary to evaluate the effects of donor cocaine use on long-term post-transplant outcomes, especially cardiac allograft vasculopathy.