Impact of Donor Substance Use on Outcomes Following Pancreas Transplantation

Donor substance use is considered by many a risk factor for poor outcomes following pancreas transplantation, yet little is known regarding the impact of donor substance use on actual outcomes. This study aimed to determine the impact of substance use, particularly cocaine, on early and late outcomes following pancreas transplantation.

This was a single center, retrospective analysis of all pancreas transplants from 2003-2023. Clinical outcomes including 30-day peak serum lipase, 7-day, 90-day, and 1-year pancreas allograft survival were assessed by donor exposure to substance use. As cocaine was of particular interest, a Kaplan-Meier analysis for positive vs negative cocaine tox screen was performed.

737 pancreas transplants were included. Donor substance use history included >20 pack years tobacco (40%) and marijuana (31%), with 11% of donors having history of cocaine use. Donor toxicology screens were positive for THC (26%), EtOH (22%), and benzodiazepines (22%). History of heavy alcohol use was associated with early allograft loss (7-day allograft loss 8% compared to 3%, p < 0.01) and EtOH positive toxicology screen was associated with higher 90-day allograft loss (8% vs 5%, p 0.02) and worse 1-year allograft survival (89% vs 93%, p < 0.01). There was no difference in clinical outcomes with donor exposure to cocaine.

Only a donor history of ETOH use was associated with worse outcomes following pancreas transplantation. Donor exposure to cocaine was not associated with inferior outcomes. Donor substance use history or positive toxicology in the setting of an otherwise acceptable pancreas allograft, should not preclude transplantation.