Background:The opioid crisis has led to an increase in available donor hearts, although questions remain about the long-term outcomes associated with the use of these organs. Prior studies have relied on historical information without examining the toxicology results at the time of organ offer. The objectives of this study were to examine the long-term survival of heart transplants in the recent era, stratified by results of toxicological testing at the time of organ offer as well as comparing the toxicology at the time of donation with variables based on reported history.Methods:The United Network for Organ Sharing database was requested as well as the donor toxicology field. Between 2007 and 2017, 23 748 adult heart transplants were performed. United Network for Organ Sharing historical variables formed a United Network for Organ Sharing Toxicology Score and the measured toxicology results formed a Measured Toxicology Score. Survival was examined by the United Network for Organ Sharing Toxicology Score and Measured Toxicology Score, as well as Cox proportional hazards models incorporating a variety of risk factors.Results:The number and percent of donors with drug use has significantly increased over the study period (P<0.0001). Cox proportional hazards modeling of survival including toxicological and historical data did not demonstrate differences in post-transplant mortality. Combinations of drugs identified by toxicology were not associated with differences in survival. Lower donor age and ischemic time were significantly positively associated with survival (P<0.0001).Conclusions:Among donors accepted for transplantation, neither history nor toxicological evidence of drug use was associated with significant differences in survival. Increasing use of such donors may help alleviate the chronic donor shortage.

中文翻译：

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醉酒捐献者和心脏移植结果：长期安全

背景：阿片类药物危机导致可用捐赠心脏的增加，尽管与使用这些器官相关的长期结果仍然存在问题。先前的研究依赖于历史信息，而没有检查器官提供时的毒理学结果。本研究的目的是检查近代心脏移植的长期存活率，根据器官提供时的毒理学测试结果进行分层，并将捐赠时的毒理学与基于报告历史的变量进行比较.方法：请求器官共享联合网络数据库以及供体毒理学领域。2007 年至 2017 年间，进行了 23 748 例成人心脏移植手术。United Network for Organ Sharing历史变量形成United Network for Organ Sharing Toxicology Score，测量的毒理学结果形成Measured Toxicology Score。存活率通过器官共享毒理学评分和测量毒理学评分联合网络以及包含各种风险因素的 Cox 比例风险模型进行检查。 结果：在研究期间，吸毒捐献者的数量和百分比显着增加（P <0.0001）。包括毒理学和历史数据在内的生存 Cox 比例风险模型并未证明移植后死亡率存在差异。毒理学鉴定的药物组合与生存差异无关。较低的供体年龄和缺血时间与存活率显着正相关（P <0.0001）。结论：在接受移植的供体中，无论是吸毒史还是毒理学证据都与存活率存在显着差异。增加对此类捐赠者的使用可能有助于缓解长期的捐赠者短缺问题。