Intravenous Methamphetamine Does Not Appear to Be a Contraindication for Heart Donation in Heart Transplantation

Purpose Intravenous methamphetamine (IV meth) use in potential heart donors has been of concern due to the possibility of methamphetamine cardiomyopathy and transmission of infections. There is also concern regarding the development of primary graft dysfunction (PGD) and cardiac allograft vasculopathy (CAV) due to possible endothelial cell dysfunction. Therefore, we reviewed our HTx data to identify those donors who primarily used IV meth in the past 6 months prior to organ donation. Methods Between 2010-2017 we identified 32 heart donors who were actively using IV meth. We compared this to 329 donors who had no history of drug use during the same time period. Endpoints included 1-year survival, 1-year freedom from CAV (as defined by stenosis ≥ 30% by angiography), non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, new congestive heart failure, percutaneous coronary intervention, implantable cardioverter defibrillator/pacemaker implant, stroke), Any-Treated Rejection (ATR), Acute-Celular Rejection (ACR), Antibody-Mediated Rejection (AMR), and Biopsy-Negative Rejection (BNR). The incidence of PGD was also assessed. Results There was no significant difference in endpoints between IV meth use in donors and those donors without meth use (see table). The incidence of PGD was also not different between the groups. Other drugs that were being abused (in combination) included heroin at 46.8% and cocaine at 9.4%. The addition of these drugs did not change outcome. Conclusion The use of donors using IV meth does not appear to be a contraindication for HTx. Longer term follow up will be necessary to confirm these findings.