Heart Transplant Outcomes in Patients with Substance Use Disorder History: A Nationwide Cohort Study Using High-Dimensional Propensity Score Matching
Heart transplant recipients with a history of substance use disorder have similar survival and organ rejection rates as those without
K Elkrief, P Lavin, KT Greenway, SD Tate, F Hussain, CW Pike, A Trepanier, G Hui, P Lespérance, I Kudrina, S Dubreucq, MJ Ostacher, D Jutras-Aswad, A Lembke, N Garel
European Heart Journal. Quality of Care & Clinical Outcomes (2025)
Plain-language summary
In our large study using health records from over 120 million Americans, we examined whether a history of substance use problems affected survival, hospital readmission, or organ rejection after a heart transplant. After carefully matching patients with and without such a history based on other health conditions and social factors, we found no meaningful differences in these outcomes at one or five years post-transplant. This challenges the common practice of using a past substance use disorder alone as a reason to deny someone a heart transplant, suggesting that other health and social factors may be more important in predicting success. Our findings highlight the need to re-evaluate transplant eligibility criteria to avoid unfairly excluding patients based solely on a history of substance use.
Abstract
AIMS: History of substance use is assessed in potential heart transplantation (HT) evaluations. The evidence base for this highly consequential practice, linking substance use disorders (SUDs) with poor post-transplantation outcomes, presents methodological limitations. We conducted a retrospective cohort study to address these limitations using high dimensional propensity score matching to compare HT outcomes of patients with and without SUDs. METHODS AND RESULTS: Key outcomes included mortality, hospitalization, and organ rejection rates, controlling for confounders. A national dataset of electronic health records of >120 million patients in the USA (2015-23) was used to identify HT patients with SUDs (n = 808) and controls (n = 7066), matched for medical comorbidities and demographic variables. Only after adjusting for sociodemographic and comorbidities of HT recipients, the results revealed no significant differences between groups with and without SUDs at 1 year in mortality [odds ratio (OR) = 0.96 (95% confidence interval, CI): 0.54, 1.69, P = 0.88], hospitalization [OR = 1.02 (95% CI: 0.83, 1.25), P = 0.840)], organ rejection rates [OR = 0.96 (95% CI: 0.78, 1.18), P = 0.670)], nor at 5 years in mortality [hazard ratio (HR) = 1.15 (95% CI: 0.82, 1.61), P = 0.410] and organ rejection [HR = 0.98 (95% CI: 0.84, 1.14), P = 0.810]. CONCLUSION: Future studies must consider confounding factors when evaluating transplant criteria and outcomes in patients with SUDs.
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Formatted
K Elkrief, P Lavin, KT Greenway, SD Tate, F Hussain, CW Pike, A Trepanier, G Hui, P Lespérance, I Kudrina, S Dubreucq, MJ Ostacher, D Jutras-Aswad, A Lembke, N Garel. Heart Transplant Outcomes in Patients with Substance Use Disorder History: A Nationwide Cohort Study Using High-Dimensional Propensity Score Matching. European Heart Journal. Quality of Care & Clinical Outcomes. 2025. doi:10.1093/ehjqcco/qcaf117BibTeX
@article{pike2025heart,
title = {Heart Transplant Outcomes in Patients with Substance Use Disorder History: A Nationwide Cohort Study Using High-Dimensional Propensity Score Matching},
author = {Elkrief, K and Lavin, P and Greenway, KT and Tate, SD and Hussain, F and Pike, CW and Trepanier, A and Hui, G and Lespérance, P and Kudrina, I and Dubreucq, S and Ostacher, MJ and Jutras-Aswad, D and Lembke, A and Garel, N},
journal = {European Heart Journal. Quality of Care & Clinical Outcomes},
year = {2025},
doi = {10.1093/ehjqcco/qcaf117},
}
RIS
TY - JOUR
AU - Elkrief, K
AU - Lavin, P
AU - Greenway, KT
AU - Tate, SD
AU - Hussain, F
AU - Pike, CW
AU - Trepanier, A
AU - Hui, G
AU - Lespérance, P
AU - Kudrina, I
AU - Dubreucq, S
AU - Ostacher, MJ
AU - Jutras-Aswad, D
AU - Lembke, A
AU - Garel, N
TI - Heart Transplant Outcomes in Patients with Substance Use Disorder History: A Nationwide Cohort Study Using High-Dimensional Propensity Score Matching
JO - European Heart Journal. Quality of Care & Clinical Outcomes
PY - 2025
DO - 10.1093/ehjqcco/qcaf117
ER -
- Publication Type
- Journal Article
- Journal
- European Heart Journal. Quality of Care & Clinical Outcomes
- Date Published
- September 30, 2025
- Digital Object Identifier
- 10.1093/ehjqcco/qcaf117
- PubMed Identifier
- 41026891