title: Long-term outcomes in heart transplantation using donors with a history of past and present cocaine use.
abstract: OBJECTIVE
  Organ donors with a history of cocaine use are thought to be less favourable for orthotopic heart transplantation (OHT). This study examined long-term survival in OHT using donors with a history of cocaine use.
  
  
  METHODS
  The United Network for Organ Sharing (UNOS) database was examined for primary, adult heart transplants from 2000 to 2010. Cox proportional hazards analysis using covariates associated with mortality was used to examine survival.
  
  
  RESULTS
  There were 19 636 total OHTs with 2274 (11.6%) using donors with a history of dependent cocaine use (DCU). Of these, 1008 (44.3%) donors were current cocaine users. Recipients of DCU were more likely to be male (79.0 vs 75.7%, P < 0.001), more likely diabetic (16.5 vs 14.8%, P = 0.003) and were less likely to be sex mismatched (23.0 vs 28.6%, P < 0.001). DCU donors were older (32.5 vs 31.4 years, P < 0.001), more likely male (79.7 vs 69.8%, P < 0.001) and had higher ischaemic times (3.27 vs 3.20 h, P = 0.001). On multivariate analysis, DCU was not associated with mortality [hazard ratio (HR): 0.95, 95% CI: 0.87-1.03, P = 0.22]. Variables associated with mortality included recipient body mass index, sex mismatch, race mismatch, black race, ischaemic time, recipient creatinine, donor age, donor smoking history and mechanical ventilation or extracorporeal membrane oxygen as a bridge to transplantation. On subset analysis, CCU was not associated with mortality (HR: 0.97, 95% CI: 0.89-1.05, P = 0.42). On Kaplan-Meier analysis, median survival was not different when comparing current (3890.0 days), past (3,889.0 days) and non-cocaine using donors (4165.0 days); P = 0.54.
  
  
  CONCLUSIONS
  Use of carefully selected donors with a history of past and current cocaine use does not result in worse outcomes.
authors.affiliation: Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Senthil
authors.initials: S
authors.lastname: Jayarajan
authors.affiliation: Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Sharven
authors.initials: S
authors.lastname: Taghavi
authors.affiliation: Department of Public Health, Temple University, Philadelphia, PA, USA.
authors.forename: Eugene
authors.initials: E
authors.lastname: Komaroff
authors.affiliation: Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Akira
authors.initials: A
authors.lastname: Shiose
authors.affiliation: Section of Cardiology, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schwartz
authors.affiliation: Section of Cardiology, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Eman
authors.initials: E
authors.lastname: Hamad
authors.affiliation: Section of Cardiology, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Rene
authors.initials: R
authors.lastname: Alvarez
authors.affiliation: Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Grayson
authors.initials: G
authors.lastname: Wheatley
authors.affiliation: Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA, USA.
authors.forename: Thomas Sloane
authors.initials: TS
authors.lastname: Guy
authors.affiliation: Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA, USA yoshiya.toyoda@tuhs.temple.edu.
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
mesh_terms: D000328:Adult; D019970:Cocaine-Related Disorders / Q000453:epidemiology*; D005260:Female; D016027:Heart Transplantation / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D019737:Transplants / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: Congestive heart failure; Heart failure; Heart transplantation