The effect of donor alcohol abuse on outcomes following heart transplantation

Area of Science:

• Cardiology
• Transplantation Immunology
• Public Health

Background:

• Current guidelines advise against using hearts from donors with a history of alcohol abuse.
• The impact of donor alcohol abuse (AA) on cardiac allograft function and outcomes in heart transplant (HTx) recipients remains under investigation.

Purpose of the Study:

• To evaluate the effect of donor alcohol abuse on cardiac allograft function and patient outcomes after heart transplantation.
• To determine if hearts from donors with a history of alcohol abuse can be safely used in heart transplantation.

Main Methods:

• A cohort of 370 heart transplant recipients was divided into two groups: those who received hearts from alcoholic donors (AD, n=58) and those who received hearts from non-alcoholic donors (NAD, n=312).
• Cardiac allograft function and patient outcomes were assessed, including heart rate, incidence of atrial fibrillation (AF), left ventricular mass, E/E' ratio, cardiopulmonary exercise testing, rejection rates, cardiac allograft vasculopathy (CAV), and survival.

Main Results:

• Recipients in the AD group exhibited a slower heart rate (P=0.004) and a higher incidence of early atrial fibrillation (30% vs 11%, P=0.003).
• Higher left ventricular mass was observed in the AD group both pre-transplant and one year post-transplant (P=0.02 and P=0.007, respectively).
• The AD group showed increased E/E' (P=0.04) and a higher prevalence of ventilatory equivalent for VCO2 > 34 during exercise testing (50% vs 31%, P=0.04), indicating impaired diastolic function.

Conclusions:

• Donor alcohol abuse did not significantly impact rejection rates, cardiac allograft vasculopathy, or intermediate-term survival after heart transplantation.
• However, donor alcohol abuse was associated with an increased incidence of post-transplant atrial fibrillation and impaired cardiac allograft diastolic function.