title: Use of Heavy Drinking Donors in Heart Transplantation is Not Associated With Worse Mortality.
abstract: BACKGROUND
  Although orthotopic heart transplantation (OHT) remains the preferred treatment for end-stage heart failure, there continues to be a critical shortage of organ donors. The goal of this study is to examine outcomes after orthotopic OHT using heavy drinking donors (HDDs) in a large, national database.
  
  
  METHODS
  The United Network for Organ Sharing database was examined for all primary, adult OHT carried out from 2005 to 2012.
  
  
  RESULTS
  There were 14,928 total OHT performed during the study period with 2,274 (15.2%) using HDD. Recipients of HDD were older (53.4 vs. 51.9 years, P < 0.001), more likely men (80.7 vs 74.4%, P < 0.001), less likely sex mismatched (21.5 vs 27.5%, P < 0.001), more likely race mismatched (57.4 vs 52.4%, P < 0.001), and had less total HLA mismatches (4.55 vs 4.65, P < 0.001). The HDD were older (37.0 vs 30.5 years, P < 0.001), more likely men (82.2 vs 69.9%, P < 0.001), and more likely to have heavy cigarette use (38.1 vs 13.2%, P < 0.001). Length of stay was not different (20.3 vs 19.7 days, P = 0.02). On multivariate analysis, use of HDD was not associated with mortality at 30 days (hazards ratio [HR], 1.12; 95% confidence interval [95% CI], 0.90-1.39; P = 0.30), 1 year (HR, 0.96; 95% CI, 0.83-1.11; P = 0.56), and at 5 years (HR, 1.02; 95% CI, 0.91-1.13; P = 0.79). Variables associated with mortality at 5 years included increasing donor age, prolonged ischemic time, worsening recipient creatinine, recipient black race, sex mismatch, and extracorporeal membrane oxygenation or mechanical ventilation as a bridge to transplantation.
  
  
  CONCLUSIONS
  Heart transplantation can be performed using carefully selected HDDs with good outcomes.
authors.affiliation: 1 Department of Surgery, Temple University School of Medicine, Philadelphia, PA. 2 Department of Public Health, Temple University, Philadelphia, PA. 3 Section of Cardiothoracic Surgery, Temple University School of Medicine, Philadelphia, PA. 4 Section of Cardiology, Temple University School of Medicine, Philadelphia, PA.
authors.forename: Sharven
authors.initials: S
authors.lastname: Taghavi
authors.forename: Senthil N
authors.initials: SN
authors.lastname: Jayarajan
authors.forename: Eugene
authors.initials: E
authors.lastname: Komaroff
authors.forename: Akira
authors.initials: A
authors.lastname: Shiose
authors.forename: Daniel
authors.initials: D
authors.lastname: Schwartz
authors.forename: Eman
authors.initials: E
authors.lastname: Hamad
authors.forename: Rene
authors.initials: R
authors.lastname: Alvarez
authors.forename: Grayson
authors.initials: G
authors.lastname: Wheatley
authors.forename: T Sloane
authors.initials: TS
authors.lastname: Guy
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Toyoda
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000009:adverse effects*; D000437:Alcoholism / Q000150:complications; D016022:Case-Control Studies; D016208:Databases, Factual; D046148:Donor Selection; D005260:Female; D016027:Heart Transplantation / Q000379:methods / Q000401:mortality*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014481:United States / Q000453:epidemiology