Heart transplant outcomes in patients with substance use disorder history: a nationwide cohort study using...

History of substance use is assessed in potential heart transplantation (HT) evaluations. The evidence base for this highly consequential practice, linking substance use disorders (SUDs) with poor post-transplantation outcomes, presents methodological limitations. We conducted a retrospective cohort study to address these limitations using high dimensional propensity score matching to compare HT outcomes of patients with and without SUDs.

Key outcomes included mortality, hospitalization, and organ rejection rates, controlling for confounders. A national dataset of electronic health records of >120 million patients in the USA (2015-23) was used to identify HT patients with SUDs (n = 808) and controls (n = 7066), matched for medical comorbidities and demographic variables. Only after adjusting for sociodemographic and comorbidities of HT recipients, the results revealed no significant differences between groups with and without SUDs at 1 year in mortality [odds ratio (OR) = 0.96 (95% confidence interval, CI): 0.54, 1.69, P = 0.88], hospitalization [OR = 1.02 (95% CI: 0.83, 1.25), P = 0.840)], organ rejection rates [OR = 0.96 (95% CI: 0.78, 1.18), P = 0.670)], nor at 5 years in mortality [hazard ratio (HR) = 1.15 (95% CI: 0.82, 1.61), P = 0.410] and organ rejection [HR = 0.98 (95% CI: 0.84, 1.14), P = 0.810].

Future studies must consider confounding factors when evaluating transplant criteria and outcomes in patients with SUDs.