DONORS WITH A HISTORY OF COCAINE USE - EFFECT ON SURVIVAL AND REJECTION FREQUENCY AFTER HEART-TRANSPLANTATION

The frequency of cocaine use among donors is currently unknown. Cocain e has cardiotoxic effects and could affect the outcome of heart transp lantation. To examine the frequency of nonintravenous cocaine use in o rgan donors and the outcome of heart transplantation with such donors, we retrospectively analyzed the clinical, biopsy, and donor informati on on 112 consecutive patients who underwent transplantation between D ecember 1988 and August 1993. Ten patients were excluded because of in complete information regarding the donor's cocaine status. Of the rema ining 102 patients, 16 (16%) had a positive donor history for nonintra venous cocaine use (cocaine group) and 86 patients (84%) had a negativ e history (noncocaine group). Survival, frequency of cellular rejectio n (grade greater-than-or-equal-to 1B), and humoral rejection were comp ared between the two groups. Survival rates at 30 days (100% versus 97 % +/- 2%) and at 1 year (93 +/- 7% versus 89 +/- 3%) were similar (p = not significant, cocaine versus noncocaine group). Freedom from rejec tion was similar at 30 days (81% +/- 10% versus 79% +/- 4% cellular re jection-free, 33% +/- 14% versus 60% +/- 6% humoral-free) and 6 months (34% +/- 12% versus 55% +/- 5% cellular-free, 16% +/- 11% versus 36% +/- 6% humoral-free) (p = not significant). No significant difference was found in donor inotropic support before procurement, ischemic time , length of stay in intensive care unit, or total stay in the hospital . In conclusion, a high incidence of nonintravenous cocaine use exists among donors. The outcome of patients who receive transplanted hearts obtained from nonintravenous cocaine users is favorable, suggesting t hat the use of such hearts is safe.