Outcomes of Heart Transplant from Donors with a History of Heavy Alcohol Use: Don't Throw the Baby Out with the Bathtub Gin

Purpose Donors with a history of heavy alcohol use (DHAU) may have subclinical cardiomyopathy, resulting in poor outcomes after heart transplantation (HT). We sought to assess short-and long-term mortality, graft failure and cardiac allograft vasculopathy (CAV) in HT recipients from DHAU. Methods The cohort included adult primary transplants between 2008 and 2017 from the ISHLT TTX registry. Between-group differences were evaluated by Wilcoxon-rank sum tests and Fisher's exact tests for continuous and dichotomous/polytomous variables, respectively. The freedom from death was characterized using the Kaplan-Meier survival methods with log-rank tests; Cox proportional hazard regression was used to quantify of DHAU. The incidence rate of CAV was characterized using a competing risk model with Gray's tests, and the association of DHAU was assessed using cause-specific hazard regression. Results A total of 21,744 HT recipients were included, of which, 3,523 were classified as DHAU. The median (IQR) follow-up time was 3.8 (1.8 - 6.2) years. Among DHAU, there was a higher proportion of heavy smokers (32% vs. 11%, p Conclusion A donor history of heavy alcohol use was not a risk factor for poor short-term outcomes; however, DHAU are associated with an increased risk of developing CAV. Recipients of such donors may benefit from more intensive monitoring and earlier initiation of CAV related therapies.