Despite the notion they are unsafe, a pair of studies demonstrate there were no significant differences in outcomes among heart transplant recipients receiving a donor heart based on a history of illicit drug use or overdose.
New research from a pair of studies suggests use of hearts from illicit drug users or overdosed patients is not only safe for transplant but could also cut wait time for recipients.
While some have shied away from use of donor heart from patients who overdosed or used illicit drugs in the past, results of one study demonstrate history nor toxicological evidence of drug use was associated in significant differences in survival among recipients and the other details improvements in survival in recent years among transplant recipients despite increases in donor hearts from patients with comorbidities and other risk factors.
“We thought that illicit drugs like cocaine or methamphetamine, which can lead to heart attacks, would prove to be dangerous,” said David Baran, MD, System Director for Advanced Heart Failure and transplantation at Sentara Heart Hospital in Virginia, who led the study examining hearts of intoxicated donors and transplant outcomes, in a press release from the American Heart Association. “However, we were wrong. We should not reject a heart from a donor just because they used one or more illicit drugs.”
A byproduct of the opioid crisis in the US has been a surge in the availability of donor hearts from individuals with historic or toxicological evidence of drug use. Despite some previous studies suggesting these hearts were safe for transplant, some institutions still refrain from using these hearts for transplantation, even if it means longer wait times for recipients. This paradox is what spurred Baran and colleagues to design their study examining the long-term outcomes in recipients of hearts from intoxicated donors compared to those from patients without a history of illicit drug use.
Using the United Network for Organ Sharing (UNOS) database, investigators identified 23,478 adult heart transplants occurring between 2007-2017. In Cox proportional hazards models, results indicated there were no statistically significant differences in post-transplant mortality based on toxicological and historic data. Investigators noted this was despite the number and percent of donors with drug use significantly increasing during the study period (P <.0001).
Further analysis indicated combinations of drugs identified by toxicology were not associated with significant differences in survival following transplant. Investigators also pointed out lower donor age and ischemic time were significantly positively associated with survival (P <.0001).
The second study, which was led by Ravi Dhingra, MD, MPH, Medical Director of the Heart Failure and Transplant Program and Associate Professor of Medicine at the University of Wisconsin-Madison, sought to examine how recent trends may have impacted the donor to transplant ratio or transplant outcomes.
In this study, investigators compared donors and recipients from 2008-2012 (n=11,654) and from 2013-2017 (n=14,556) to counterparts from 2003-2007 (n=10,869) using information obtained from the UNOS. Using Cox models, investigators designed their analyses to assess 30-day and 1-year risk of recipient death following transplant.
Initial assessments revealed donor hearts from 2013-2017 were older, heavier, more hypertensive, diabetic, and likely to have bused illicit drugs compared to previous years. In Cox models, results indicated the risk of death following transplant from 2013-2017 was 15% lower at 30 days (HR, 0.85; 95% CI, 0.74-0.98) and 21% lower at 1 year (HR, 0.79; 95% CI, 0.73-0.87) compared to transplants from 2003-2007. Additionally, transplants occurring from 2008-2012 had a 9% lower risk of death at 30 days (HR, 0.91; 95% CI, 0.79-1.05) and a 14% lower risk of death at 1 year (HR, 0.86; 95% CI, 0.79-0.94) than their counterparts who received transplant from 2003-2007.
“This research confirms previous data that these hearts – once considered high risk – are safe,” said Howard Eisen, MD, chair of the American Heart Association’s Heart Failure and Transplantation Committee of the Clinical Cardiology Council, who not involved in either study, in the aforementioned release. “These findings should encourage institutions who are not routinely using hearts from drug users to do so. It will reduce the waiting time and the number of deaths among people on the heart transplant waitlist.”
These studies, “Intoxicated Donors and Heart Transplant Outcomes,” and “National Trends in Heart Donor Usage Rates: Are We Efficiently Transplanting More Hearts?”, were published in Circulation: Heart Failure and the Journal of the American Heart Association, respectively.