title: Donors with a history of cocaine use: effect on survival and rejection frequency after heart transplantation.
abstract: The frequency of cocaine use among donors is currently unknown. Cocaine has cardiotoxic effects and could affect the outcome of heart transplantation. To examine the frequency of nonintravenous cocaine use in organ donors and the outcome of heart transplantation with such donors, we retrospectively analyzed the clinical, biopsy, and donor information on 112 consecutive patients who underwent transplantation between December 1988 and August 1993. Ten patients were excluded because of incomplete information regarding the donor's cocaine status. Of the remaining 102 patients, 16 (16%) had a positive donor history for nonintravenous cocaine use (cocaine group) and 86 patients (84%) had a negative history (noncocaine group). Survival, frequency of cellular rejection (grade > or = 1B), and humoral rejection were compared between the two groups. Survival rates at 30 days (100% versus 97% +/- 2%) and at 1 year (93 +/- 7% versus 89 +/- 3%) were similar (p = not significant, cocaine versus noncocaine group). Freedom from rejection was similar at 30 days (81% +/- 10% versus 79% +/- 4% cellular rejection-free, 33% +/- 14% versus 60% +/- 6% humoral-free) and 6 months (34% +/- 12% versus 55% +/- 5% cellular-free, 16% +/- 11% versus 36% +/- 6% humoral-free) (p = not significant). No significant difference was found in donor inotropic support before procurement, ischemic time, length of stay in intensive care unit, or total stay in the hospital. In conclusion, a high incidence of nonintravenous cocaine use exists among donors. The outcome of patients who receive transplanted hearts obtained from nonintravenous cocaine users is favorable, suggesting that the use of such hearts is safe.
authors.affiliation: Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, CA 90048.
authors.forename: D
authors.initials: D
authors.lastname: Freimark
authors.forename: L S
authors.initials: LS
authors.lastname: Czer
authors.forename: D
authors.initials: D
authors.lastname: Admon
authors.forename: I
authors.initials: I
authors.lastname: Aleksic
authors.forename: M
authors.initials: M
authors.lastname: Valenza
authors.forename: P
authors.initials: P
authors.lastname: Barath
authors.forename: D
authors.initials: D
authors.lastname: Harasty
authors.forename: C
authors.initials: C
authors.lastname: Queral
authors.forename: C G
authors.initials: CG
authors.lastname: Azen
authors.forename: C
authors.initials: C
authors.lastname: Blanche
mesh_terms: D000328:Adult; D002423:Cause of Death; D003042:Cocaine; D005260:Female; D006084:Graft Rejection; D016027:Heart Transplantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D019966:Substance-Related Disorders; D015996:Survival Rate; D014019:Tissue Donors
chemical_list: D003042:Cocaine