Abstract 4371850: Midterm Rejection and Re-Admission Outcomes in Orthotopic Heart Transplant Recipients with a History of Methamphetamine Use

Background: Methamphetamine Use (MU) is a growing public health concern across the United States and is associated with dilated cardiomyopathy and pulmonary hypertension. For those with end-stage disease, advanced therapies considerations such as heart transplant may be lifesaving; however, these patients are often excluded from candidacy due to MU history. Concerns for MU relapse resulting in missed immunosuppression and risk of rejection is a major concern. In this study, we describe a large single center experience describing outcomes and rates of rejection following Orthotopic Heart Transplant (OHT) in patients with a history of MU. Methods: All consecutive patients transplanted at our center from January 2020 to June 2023 were included. A total of 31 recipients with a history of MU were identified. We evaluated 30-day re-admission and rejection rates following transplant between MU and non-MU recipients. Results: A total of 279 OHT recipients were included, 31 with MU. Patients with MU disorder were more likely to be younger age (51 vs 57, p= 0.04), have more tobacco use (77% vs 34%, P < 0.01) and higher SIPAT scores (31 vs 19, p < 0.01). Over an average follow up time of 29 months, there was no difference in survival between the MU and non-MU groups (96.8% vs 90.3%, p = 0.24), rates of 30-day rehospitalization (22.6% vs 20.5%, p = 0.79), rates of antibody mediated rejection (6.5% vs 9.7%, p = 0.56), and rates of severe cellular rejection (6.5% vs 14.2%, p = 0.23). Conclusion: In short term follow up, we demonstrate similar rates of death, rehospitalization, and rejection between MU and non-MU OHT recipients, suggesting that OHT may be an option for a select population with MU. Further study describing use history, relapse and treatment is crucial to understanding the success of these patients.