Impact of donor high-risk social behaviors on recipient survival in cardiac transplantation.
OBJECTIVE
To investigate the impact of cardiac donor participation in high-risk social behaviors (HRSBs) on recipient survival.


METHODS
Retrospective chart review queried cardiac transplantations performed at our institution from August 1994 to November 2007 involving donors known to have engaged in HRSBs. Kaplan-Meier methodology was used to analyze survival rates, and a Cox proportional hazards regression was performed to determine the impact of donor HRSBs on survival.


RESULTS
We identified 143 donors with social histories containing the following HRSBs: incarceration (n=69), unprofessional tattoos or piercings (n=44), alternative lifestyle practice (n=11), cocaine use (n=60), heroin smoking (n=6), marijuana use (n=79), oral narcotic abuse (n=20), and intravenous drug use (n=21). At the time of donation, viral screens detected 10 donors who were hepatitis B virus (HBV) positive, 11 donors who were hepatitis C virus (HCV) positive, and no donors who were positive for the HIV. One-year and 5-year survival were 92.2% and 84.4%, respectively. Cox regression analysis found only donor HCV infection to be associated with poorer recipient survival (P=0.14).


CONCLUSIONS
Using cardiac allografts from high-risk donors who are serologically negative for viruses does not seem to impact recipient survival. There is a considerable risk for transmission of HBV and HCV when these are detected by pretransplant screens. However, if pretransplant screening does not discover donor HBV, HCV, or HIV infection, it is unlikely that subclinical disease transmission will occur.
Xu
David S
DS
The Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
Hartman
Deanna
D
Ludrosky
Kristin
K
Campbell
James
J
Starling
Randall C
RC
Taylor
David O
DO
Smedira
Nicholas G
NG
Gonzalez-Stawinski
Gonzalo V
GV
D000328:Adult; D046288:Body Piercing / Q000009:adverse effects; D003415:Crime; D046148:Donor Selection; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000635:transmission; D016027:Heart Transplantation / Q000009:adverse effects / Q000401:mortality*; D006509:Hepatitis B / Q000175:diagnosis / Q000635:transmission; D006526:Hepatitis C / Q000175:diagnosis / Q000635:transmission; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011329:Prisoners; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior; D012919:Social Behavior; D019966:Substance-Related Disorders / Q000150:complications; D013653:Tattooing / Q000009:adverse effects; D013997:Time Factors; D014019:Tissue Donors / Q000523:psychology / Q000600:supply & distribution*; D014184:Transplantation, Homologous; D016896:Treatment Outcome