Donor Drug Overdose Not Associated with Primary Graft Dysfunction after Heart Transplantation

PurposePrimary graft dysfunction (PGD) is a leading cause of early morbidity and mortality following heart transplantation (HTx). Over the past decade, there has been a marked increase in availability of hearts from drug overdose donors (DOD) as a result of the opioid epidemic. The purpose of this study was to determine the association between DOD and development of PGD.MethodsA total of 492 consecutive adult patients underwent HTx from 1/2010 to 7/2020 at a single center. Multiorgan transplants were excluded. DOD was defined as death due to drug overdose or active drug use at time of death (if cause of death was unclear) as reported by United Network for Organ Sharing. Definition of PGD was based on the 2014 ISHLT consensus: dependence on extracorporeal membrane oxygenation (severe) or new requirement for intra-aortic balloon pump (moderate).ResultsThere were 64 (13.0%) donors who had DOD. Severe PGD was observed in 22 (4.5%) patients and 45 (9.1%) had moderate PGD. Over the past decade, we observed a significant increase in the number of DOD per year (4.7% in 2010 vs. 18.8% in 2019). There was no difference in baseline recipient and donor characteristics, other than a higher prevalence of hepatitis C antibodies in DOD donors (8.5% vs. 0.7%, p<0.001) (Table 1). Recipients of hearts from DOD had similar incidence of moderate or severe PGD compared to those who received hearts from donors with other causes of death (15.6% vs. 13.3%, p=0.62). Recipients of DOD did not adversely affect 2-year overall post-HTx survival (88.6% vs. 89.3%, p=0.57) (Figure 1).ConclusionCompared to non-DOD donors, DOD donors did not have a significantly different incidence in moderate or severe PGD or 2-year survival. Primary graft dysfunction (PGD) is a leading cause of early morbidity and mortality following heart transplantation (HTx). Over the past decade, there has been a marked increase in availability of hearts from drug overdose donors (DOD) as a result of the opioid epidemic. The purpose of this study was to determine the association between DOD and development of PGD. A total of 492 consecutive adult patients underwent HTx from 1/2010 to 7/2020 at a single center. Multiorgan transplants were excluded. DOD was defined as death due to drug overdose or active drug use at time of death (if cause of death was unclear) as reported by United Network for Organ Sharing. Definition of PGD was based on the 2014 ISHLT consensus: dependence on extracorporeal membrane oxygenation (severe) or new requirement for intra-aortic balloon pump (moderate). There were 64 (13.0%) donors who had DOD. Severe PGD was observed in 22 (4.5%) patients and 45 (9.1%) had moderate PGD. Over the past decade, we observed a significant increase in the number of DOD per year (4.7% in 2010 vs. 18.8% in 2019). There was no difference in baseline recipient and donor characteristics, other than a higher prevalence of hepatitis C antibodies in DOD donors (8.5% vs. 0.7%, p<0.001) (Table 1). Recipients of hearts from DOD had similar incidence of moderate or severe PGD compared to those who received hearts from donors with other causes of death (15.6% vs. 13.3%, p=0.62). Recipients of DOD did not adversely affect 2-year overall post-HTx survival (88.6% vs. 89.3%, p=0.57) (Figure 1). Compared to non-DOD donors, DOD donors did not have a significantly different incidence in moderate or severe PGD or 2-year survival.