Use of hearts from donors dying from overdose does not impact transplant survival
Using hearts from donors who died from a drug overdose does not reduce transplant recipient survival, so making more of those hearts available could decrease heart transplant wait times, according to two studies.
“Given the continued donor shortage and high waitlist mortality rate, efforts are being undertaken to improve utilization of donor hearts and specifically to consider transplanting hepatitis C virus positive or opioid overdose death donor hearts,” Naga Dharmavaram, MD, internal medicine physician and research fellow at the University of Wisconsin Hospital and Clinics, Madison, Wisconsin, and colleagues wrote in the Journal of the American Heart Association.
Donor heart availability
The study by Dharmavaram and colleagues examined characteristics of 11,654 donors and recipients from 2008 to 2012 and 14,556 donors and recipients from 2013 to 2017 and compared them to with 10,869 donors and recipients from 2003 to 2007. Researchers also examined 30-day and 1-year risk for recipient death post-transplant.
Researchers observed an increase in the number of transplanted hearts and donor offers but a decrease in the ratio of hearts that were transplanted to available donors from 2013 to 2017. Heart donors between 2013 to 2017 tended to be older, heavier, more hypertensive and more diabetic, as well as likely to have used illicit drugs compared with donors in previous years.
There was a significant increase in the availability of donors with hepatitis C virus (RR per year = 1.08; P = .001) and an increase in donors who died of drug overdose (RR per year = 1.18; P < .001) since 1995. Due to novel and effective antiviral therapy, hearts from donors with hepatitis C virus were accepted for transplant with an increased frequency (RR per year = 1.07; P = .02). In addition, the researchers wrote, the increase in overdose deaths since 2010 led to a proportionate increase in the number of transplants performed using hearts from overdose deaths (RR per year = 1.18; P < .001).
Compared with 2003 to 2007, risk for mortality after heart transplant was reduced in 2008 to 2012 (HR at 30 days = 0.91; 95% CI, 0.79-1.05; HR at 1 year = 0.86; 95% CI, 0.79-0.94) and in 2013 to 2017 (HR at 30 days = 0.85; 95% CI, 0.74-0.98; HR at 1 year = 0.79; 95% CI, 0.73-0.87), Dharmavaram and colleagues wrote.
Post-transplant mortality
Another study analyzed 23,748 records of heart transplantation from the United Network for Organ Sharing database from January 2007 to December 2017 to assess post-transplant survival at 1, 5 and 10 years.
“Achieving excellent heart transplant outcomes is dependent on donor selection, as primary graft dysfunction may result in adverse outcomes,” David A. Baran, MD, and colleagues wrote in Circulation: Heart Failure. “Although there are many aspects considered with evaluating a donor heart, the social history and circumstances of death are critical elements.”
During the study period, the number of percent of donors with a history of drug use significantly increased over time with 41.3% in 2007, 54.3% in 2012 and 63.4% in 2017 (P < .0001). In addition, researchers found no differences in post-transplant mortality between donors with a history of drug use and donors without, and no association between combinations of drugs and differences in survival.
Lower heart donor age (HR = 1.11; 95% CI, 1.08-1.13) and ischemic time (HR = 1.09; 95% CI, 1.07-1.12) were significantly associated with positive survival outcomes (P < .0001).
“We thought that illicit drugs like cocaine or methamphetamine, which can lead to heart attacks, would prove to be dangerous,” Baran said in a related press release. “However, we were wrong. We should not reject a heart from a donor just because they used one or more illicit drugs.”
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