Lung Transplantation From Donors With a History of Substance Use

Substance use is common among lung transplant donors, but concerns persist about graft damage. Stimulant drugs such as cocaine and methamphetamine can induce pulmonary arterial hypertension, while smoked products such as cannabis and crack cocaine can produce airway and parenchymal diseases. We sought to characterize donor substance use at our center and evaluate the associations with recipient survival as well as chronic lung allograft dysfunction (CLAD), severe primary graft dysfunction (PGD3), and baseline lung allograft dysfunction (BLAD).

We studied patients with double lung transplants in our program between 2004 and 2016, including a history of donor substance use with nine pre-specified agents. We modeled the association with time to death or retransplant, CLAD, severe PGD, and BLAD.

Of 473 recipients, 186 (39%) received lungs from a donor with a history of substance use with at least one of the pre-specified substances. There was no overall relationship between donor substance use and any outcome. Heavy donor smoking was associated with an increased risk of death or retransplant (hazard ratio 1.47; p = 0.032), PGD3 (odds ratio [OR]: 2.13; p = 0.014), and BLAD (OR 2.56; p < 0.001). Donor crack cocaine use (n = 24) was also associated with worse survival (HR 2.16; 95% CI 1.16-3.66; p = 0.017) but not CLAD or BLAD. We noted no CLAD associations with any drug.

A history of donor substance use was common and in general not associated with worse outcomes, aside from heavy donor smoking. These findings may have implications for allocation and post-transplant graft dysfunction.