The Effect of Donor Alcohol Abuse on Outcomes Following Heart Transplantation

Background Despite the limited donor pool, current guidelines recommend against the use of hearts from donors that abuse alcohol. Study aim To explore the effect of donor alcohol abuse (AA) on cardiac allograft arrhythmias, function, and outcomes in heart transplant (HTx) recipients. Methods Overall, 370 HTx recipients transplanted between 2005 and 2016 were divided into two groups: (1) the AA donor group (AD, n=58), and (2) the non-AA donor group (NAD, n=312). The median follow-up was 4.0 (25%-75% IQR 1.8-5.8) years. Results Recipients in the AD group had a slower heart rate (HR, 86±13 vs. 93±13, p=0.004) and an increased incidence of early atrial fibrillation [17 (30%) vs. 34 (11%), p=0.003]. Echocardiographic left ventricular mass was higher in AA donors (171.7±66.7 vs. 151.6±54.7, p=0.02). This difference became even more prominent 1 year following HTx (185±43 vs. 166±42, p=0.007). E/E’ was higher in the AD group (9.5±3.9 vs. 8.4±2.9, p=0.04) and a larger number of AD recipients had a ventilatory equivalent for VCO 2 >34 (50% vs. 31%, p=0.04) on cardiopulmonary stress test. There was no significant difference in rejection, cardiac allograft vasculopathy (CAV), or survival between the groups. Conclusions Our data suggest that donor AA is associated with an increased incidence of post-HTx atrial fibrillation and impaired cardiac allograft diastolic function. Therefore, although the incidence of rejection, CAV, and intermediate-term survival were not affected, hearts from donors that abuse alcohol should be used with caution.