Jayarajan Senthil, Taghavi Sharven, Komaroff Eugene, Shiose Akira, Schwartz Daniel, Hamad Eman, Alvarez Rene, Wheatley Grayson, Guy Thomas Sloane, Toyoda Yoshiya
Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA.
Department of Public Health, Temple University, Philadelphia, PA, USA.
Eur J Cardiothorac Surg. 2015 Apr;47(4):e146-50. doi: 10.1093/ejcts/ezu512. Epub 2015 Jan 9.
Organ donors with a history of cocaine use are thought to be less favourable for orthotopic heart transplantation (OHT). This study examined long-term survival in OHT using donors with a history of cocaine use.
The United Network for Organ Sharing (UNOS) database was examined for primary, adult heart transplants from 2000 to 2010. Cox proportional hazards analysis using covariates associated with mortality was used to examine survival.
There were 19 636 total OHTs with 2274 (11.6%) using donors with a history of dependent cocaine use (DCU). Of these, 1008 (44.3%) donors were current cocaine users. Recipients of DCU were more likely to be male (79.0 vs 75.7%, P < 0.001), more likely diabetic (16.5 vs 14.8%, P = 0.003) and were less likely to be sex mismatched (23.0 vs 28.6%, P < 0.001). DCU donors were older (32.5 vs 31.4 years, P < 0.001), more likely male (79.7 vs 69.8%, P < 0.001) and had higher ischaemic times (3.27 vs 3.20 h, P = 0.001). On multivariate analysis, DCU was not associated with mortality [hazard ratio (HR): 0.95, 95% CI: 0.87-1.03, P = 0.22]. Variables associated with mortality included recipient body mass index, sex mismatch, race mismatch, black race, ischaemic time, recipient creatinine, donor age, donor smoking history and mechanical ventilation or extracorporeal membrane oxygen as a bridge to transplantation. On subset analysis, CCU was not associated with mortality (HR: 0.97, 95% CI: 0.89-1.05, P = 0.42). On Kaplan-Meier analysis, median survival was not different when comparing current (3890.0 days), past (3,889.0 days) and non-cocaine using donors (4165.0 days); P = 0.54.
Use of carefully selected donors with a history of past and current cocaine use does not result in worse outcomes.
有可卡因使用史的器官捐献者被认为不太适合原位心脏移植（OHT）。本研究调查了使用有可卡因使用史的捐献者进行OHT的长期生存率。
对器官共享联合网络（UNOS）数据库中2000年至2010年的原发性成人心脏移植进行检查。使用与死亡率相关的协变量进行Cox比例风险分析来研究生存率。
共有19636例OHT，其中2274例（11.6%）使用了有可卡因依赖使用史（DCU）的捐献者。其中，1008例（44.3%）捐献者为当前可卡因使用者。DCU的接受者更可能为男性（79.0%对75.7%，P<0.001），更可能患有糖尿病（16.5%对14.8%，P=0.003），且不太可能存在性别不匹配（23.0%对28.6%，P<0.001）。DCU捐献者年龄更大（32.5岁对31.4岁，P<0.001），更可能为男性（79.7%对69.8%，P<0.001），且缺血时间更长（3.27小时对3.20小时，P=0.001）。多因素分析显示，DCU与死亡率无关[风险比（HR）：0.95，95%置信区间：0.87-1.03，P=0.22]。与死亡率相关的变量包括接受者体重指数、性别不匹配、种族不匹配、黑人种族、缺血时间、接受者肌酐、捐献者年龄、捐献者吸烟史以及作为移植桥梁的机械通气或体外膜肺氧合。亚组分析显示，CCU与死亡率无关（HR：0.97，95%置信区间：0.89-1.05，P=0.42）。Kaplan-Meier分析显示，比较当前（3890.0天）、过去（3889.0天）和无可卡因使用史的捐献者（4165.0天）时，中位生存期无差异；P=0.54。
使用精心挑选的有过去和当前可卡因使用史的捐献者不会导致更差的结果。
