Donor Substance Abuse And Heart Transplantation Outcomes.

Heart failure (HF) affects about 64.3 million individuals worldwide and 6.2 million adults in the United States. Heart transplantation continues to be the gold standard for treatment of advanced HF. The International Society for Heart and Lung Transplantation (ISHLT) recognizes drug abuse including legalized substances like alcohol and tobacco as an absolute contraindication for heart transplantation but provides vague guidance on some other substances. In this review, we analyze the literature on the hearts of donors with prior substance use and focus on outcomes of heart transplantation such as survival, rejection, and allograft vasculopathy. The authors independently searched PubMed reviewing articles published till December 31, 2021 and using the following terms: "Alcohol" AND "Donor" AND "Heart Transplantation". The last two terms remained the same while we also used them in combination with "Cocaine", "Marijuana", "Tobacco", "Smoking", "Methamphetamine", "Opioids" and "Nicotine". We also manually searched the references in all pertinent articles. The search was limited to English language. Articles describing pediatric patients were excluded. We selected the studies with the data on the outcomes of cardiac transplantation, specifically survival, incidence of rejection, and allograft vasculopathy. The data of the 27 studies meeting our criteria were included in this review. Regarding cocaine use, 5 studies evaluated heart transplantation outcomes in donors with history of cocaine use. Interestingly, no study found any increase of mortality, rejection, or allograft vasculopathy when the donor hearts with current or prior cocaine use were accepted. Despite early reports suggesting poor outcomes of heart transplant from donors with alcohol use, more recent studies show no increased risk of mortality, rejection, or allograft vasculopathy as shown in the table. Nicotine use among donors in heart transplantation was associated with worse outcomes in the 4 studies that were included in the analysis. Among the studies that looked at the effect of opioid use in donors for heart transplantation, none showed increased mortality, rejection, or allograft vasculopathy. Our study provides insight towards the consideration of heart transplant from donors with history of substance use. The presented evidence demonstrates the safety of using donor hearts from patients with history of cocaine, alcohol, and opioid use. Despite the limitations in interpreting the presented evidence, our paper provides insight that should drive future research targeted into the evaluation of substance use in heart transplant. [ABSTRACT FROM AUTHOR]