(640) Is Recipient Survival Following Transplantation of Hearts from Substance Abuse Donors Impacted by Regional Variations?

PURPOSE: Substance abuse (SA) disproportionately impacts underserved communities, more so in the ongoing COVID-19 pandemic. Though recent studies have demonstrated minimal impact on long-term survival for recipients of hearts from SA donors (SADs), there is a paucity of work on the societal implications of where and in whom such hearts are transplanted. The purpose of this study was to evaluate regional and socioeconomic factors of patients receiving hearts from alcohol and cocaine-using donors. METHODS: We evaluated the United Network for Organ Sharing (UNOS) registry for adult heart transplant recipients (HTX-R) from 2010 to 2022. Donors were grouped by heavy alcohol use, cocaine use, both, or neither. Survival analysis assessed the effect of donor SA, recipient work status and residence adjusting for demographics. RESULTS: Among 24,445 HTX-R, donor SA was unassociated with mortality, but living in the South increased risk (HR=1.22; 1.12-1.33) as did Black race and older age (donors and recipients). Higher education and working at listing were protective. Additional post hoc models found no interaction between HTX-R Black race and donor SA or HTX-R South residence and donor SA. CONCLUSION: Donor alcohol and cocaine abuse, both separately and used in conjunction, did not impact overall mortality of heart transplant recipients. Though positive indicators of increased socioeconomic status (higher education and work status) did appear protective, and while living in the South did have a negative impact on HTx survival, these factors appear to be independent of receiving hearts from SADs.