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Survival rates after a heart transplant are not affected if the organ donor has used illicit drugs or died of an overdose, a fact that increases the availability of hearts due to increased deaths from drug overdose in the United States, according to two new unrelated research. studies published today in two of the scientific journals of the American Heart Association.
In a heart transplant, the patient’s failed heart is replaced with a healthy heart from a recently deceased donor. The most common reasons for a heart transplant are that one or both ventricles of the heart are not working properly or that severe heart failure is present. In 2019, the United States recorded the highest number of heart transplants, with 3,552 transplants performed. As of March 11, 2020, 3,661 people were on the waiting list for a heart transplant, and 52 people were on the waiting list for a heart and lung transplant, according to the 2021 statistical update from the American Heart Association on heart disease and stroke.
According to Howard Eisen, MD, chair of the American Heart Association’s Clinical Cardiology Committee, data made available in 2019 showed “no downside” to heart transplants from people who have used illicit drugs. Conseil, who did not participate in any of these studies.
“This research confirms previous data that these hearts – once considered high risk – are safe,” Eisen said. “These results should encourage institutions that do not routinely use the hearts of addicts to do so. This will reduce the wait time and the number of deaths among those on the waiting list for heart transplants.”
The first study, “Poisoned donors and heart transplant outcomes: long-term safety,” looked at data from 2007 to 2017 and is published today in Circulation: heart failure, a journal of the American Heart Association.
Unfortunately, the opioid epidemic has led to an increase in potential donation of hearts, however, many of these hearts are not being used due to concerns that the donor’s illicit drug use could reduce the recipients’ chances of survival. heart transplant, explained lead author David. A. Baran, MD, system director for advanced heart failure and transplantation at Sentara Heart Hospital in Norfolk, Virginia.
In the largest study to date examining illicit drug use in heart transplant donors, and the only analysis to examine donor toxicology data obtained during hospital admission, Baran and colleagues looked at national information from the United Network for Organ Sharing (UNOS) database. They examined donor illicit drug use in a comparison of survival after heart transplantation for more than 23,000 adult heart transplant recipients between January 1, 2007 and December 31, 2017. The UNOS maintains a register of all heart transplant recipients. organ transplant activities in the United States and documents donor and recipient information, including illicit drug use by organ donors.
In this analysis, the average age of heart donors was 32 years and the average age of heart transplant recipients was 53 years. Using information from urine tests done in hospitals before donors died, the researchers identified the type and number of illicit drugs the donors had used. , including opioids, cocaine, methamphetamine, alcohol, marijuana, barbiturates, amphetamines, phencyclidine (PCP) and others. The researchers noted that alcohol use appeared to decrease over the decade of the analysis period, while all other drug use increased.
Baran and colleagues found that the percentage of transplant recipients who survived was comparable between transplant recipients who received a heart from a donor who used illicit drugs and those whose donors did not use drugs. . For example, the percentage of surviving heart transplant patients whose donors used opioids and those whose donors did not use opioids was about 90% after one year; about 77% at five years and about 60% at 10 years. The results were comparable for other types of illicit drugs, even among heart donors who tested positive for several – five or more – illicit drugs.
“We thought illicit drugs like cocaine or methamphetamine, which can cause heart attacks, would prove dangerous,” Baran said. “However, we were wrong. We should not reject a donor’s heart just because he or she has used one or more illicit drugs.”
The main limitation is that the study only included hearts that were accepted for transplantation. Other limitations include the medical administration of opioids in hospital which could be misleading, the possibility of errors when entering information into the database, and the lack of a central laboratory to confirm the results. submitted by local laboratories.
The co-authors are Justin Lansinger, BA; Ashleigh Long, MD, Ph.D .; John M. Herre, MD; Amin Yehya, MD; Edward J. Sawey, MD; Amit P. Badiye, MD; Wayne Old, MD; Jack Copeland, MD; Kelly Stelling, IA; and Hannah Copeland, MD The study received no external funding.
The second study, “National Trends in Heart Donor Utilization Rates: Are We Transplanting More Hearts Effectively?” »Comparison of data from 2003-2007 to 2013-2017. The article published today in the Journal of the American Heart Association, an open access journal of the American Heart Association.
Wisconsin researchers suggest that broader acceptance of hearts from donors who have died of drug overdoses or from donors with hepatitis C could ease pressure on the current waiting list for heart transplants.
“We hope that patients awaiting transplants are encouraged to accept hearts from donors with hepatitis C or who have died of a drug overdose, if their health care team considers the donor heart to be compatible.” said lead study author Ravi. Dhingra, MD, MPH, medical director of the Heart Failure and Transplant Program and Associate Professor of Medicine at the University of Wisconsin-Madison.
Dhingra and her colleagues investigated whether the donor pool should include people who have died of drug overdoses or who have hepatitis C. Hepatitis C is a viral infection of the liver that is spread by contact with contaminated blood, for example from shared needles; from mother to child during pregnancy and childbirth; or due to an organ transplant from a person infected with hepatitis C. Since the infection can be treated with the advent of new direct-acting antiviral drugs, hepatitis C is much more manageable , resulting in increased organ availability from donors who had hepatitis C.
They noted that doctors are required to obtain separate consents from patients regarding the acceptance of organs from hepatitis C donors and prior authorization from health insurance companies to cover the cost of hepatitis drugs. C, if the transplant recipient needs it.
“About 20% of patients on the heart transplant waiting list die while waiting for a transplant or become too sick to remain good transplant candidates,” Dhingra said.
Dhingra and her colleagues searched the UNOS database to compare the number of hearts from donors accepted or refused for transplantation from 1995 to 2018. They compared the survival of heart transplant recipients from donors who died of drug overdose or of hepatitis C to the survival of donors who had not died of a drug overdose or had hepatitis C.
Compared with heart organ donors from 2003 to 2007, donors from 2013 to 2017 were older, weighed more, were more likely to have high blood pressure and diabetes, and to have used illicit drugs, which increases the risk of risk of hepatitis C. However, compared to 2003-2007 donors, the risk of death in transplant recipients in 2013-2017 was 15% lower one month after heart transplant and 21% lower one year later.
The study looked at the main additional risk factors in transplant recipients that might have affected survival after heart transplantation, although it could not prove the cause and effect between the characteristics of the donor or the donor. recipient and survival after transplant.
The co-authors are Naga Dharmavaram, MD; Timothy Hess, Ph.D .; Heather Jaeger, IA; Jason Smith, MD; Joshua Hermsen, MD; and David Murray, MD The study was funded by the Health Resources and Services Administration and the National Heart, Lung, and Blood Institute of the National Institutes of Health.
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