HEARTS FROM DONORS WITH CHRONIC ALCOHOL-USE - A POSSIBLE RISK FACTOR FOR DEATH AFTER HEART-TRANSPLANTATION

Background: Careful donor and recipient selection are important factor s for the success of heart transplantation. Currently, donors with a h istory of alcohol use are routinely accepted despite the potential del eterious effects of alcohol on the heart. Methods: We examined the fre quency of chronic alcohol use (>2 ounces of pure alcohol daily for gre ater than or equal to 3 months) among organ donors and the outcome of the recipients after heart transplantation. Of 99 consecutive patients who underwent transplantation between December 1988 and August 1993 w ith an adequate donor history, 17 (17%) had a history of chronic alcoh ol use (alcohol group), and 82 (83%) did not (nonalcohol group). All r ecipients received triple-drug immunosuppression, and 10 to 14 days of OKT3. Results: Survival rates at 1 and 2 years were significantly low er in the alcohol group (61% +/- 13% and 61% +/- 13%) than in the nona lcohol group (95% +/- 3% and 91% +/- 4%, p = 0.0001). Most deaths in t he alcohol group occurred within 3 months after transplantation. The i ncidence of rejection episodes did not differ significantly. Fatal rej ection occurred more frequently in the alcohol group and was associate d with severe ventricular dysfunction before death. Cox multiple regre ssion analysis identified donor alcohol use as an independent risk fac tor for death after heart transplantation. Conclusions: A substantial proportion (17%) of heart donors have a history of chronic alcohol use . The unfavorable early outcome of patients receiving hearts from alco holic donors suggests the presence of a subclinical alcoholic cardiomy opathy before transplantation and poor tolerance of rejection episodes after transplantation. Larger prospective studies are needed to deter mine the mechanism of fatal rejection and whether such hearts can be u sed safely for transplantation.