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The Effect of the Opioid Epidemic on Donation After Circulatory Death Transplantation Outcomes

Wanis, Kerollos Nashat, MD1,2; Madenci, Arin L., MD2; Dokus, M. Katherine, MPH3; Tomiyama, Koji, MD, PhD4; Al-Judaibi, Bandar M., MBBS3; Hernán, Miguel A., MD, DrPH5,6; Hernandez-Alejandro, Roberto, MD4

doi: 10.1097/TP.0000000000002467
Original Clinical Science—General
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Background. The opioid epidemic and the deaths of otherwise healthy individuals due to drug overdose in the United States has major implications for transplantation. The current extent and safety of utilization of liver and kidney grafts from donation after circulatory death (DCD) donors who died from opioid overdose is unknown.

Methods. Using national data from 2006 to 2016, we estimated the cumulative incidence of graft failure for recipients of DCD grafts, comparing the risk among recipients of organs from donors who died of anoxic drug overdose and recipients of organs from donors who died of other causes.

Results. One hundred seventy-nine (6.2%) of 2908 liver graft recipients and 944 (6.1%) of 15520 kidney graft recipients received grafts from donors who died of anoxic drug overdose. Grafts from anoxic drug overdose donors were less frequently used compared with other DCD grafts (liver, 25.9% versus 29.6%; 95% confidence interval [CI] for difference, −6.7% to −0.7%; kidney, 81.0% versus 84.7%; 95% CI for difference, −7.3% to −0.1%). However, the risk of graft failure at 5 years was similar for recipients of anoxic drug overdose donor grafts and recipients of other grafts (liver risk difference, 1.8%; 95% CI, −7.8% to 11.8%; kidney risk difference, −1.5%; 95% CI, −5.4% to 3.1%).

Conclusions. In the context of the current opioid epidemic, utilization of anoxic drug overdose DCD donor grafts does not increase the risk of graft failure and may help to address waitlist demands.

1 Department of Surgery, Western University, Ontario, Canada.

2 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.

3 Division of Transplantation, University of Rochester, Rochester, NY.

4 Division of Transplantation/Hepatobiliary Surgery, Department of Surgery, University of Rochester, Rochester, NY.

5 Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA.

6 Harvard-MIT Division of Health Sciences and Technology, Cambridge, MA.

Received 18 July 2018. Revision received 26 August 2018.

Accepted 21 September 2018.

M.H. and R.H.A. contributed to this work equally as senior authors.

The authors declare no funding or conflicts of interest.

K.N.W., A.M., K.D., M.H., and R.H.A. participated in the study conception and design. K.N.W., A.M., and M.H. participated in the data analysis. K.N.W., M.H., and R.H.A. wrote the article. A.M., K.D., K.T., and B.A.-J. provided critical revisions of the manuscript for important intellectual content.

SRTR disclaimer: The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contractor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government.

Correspondence: Kerollos N. Wanis, MD, Department of Surgery, Western University, London Health Sciences Centre, Rm. C8-114, London, Ontario, Canada N6A 5A5. (knwanis@g.harvard.edu).

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