*Purpose: Donors with a history of heavy alcohol use have been suspected to possibly harbor a subclinical alcoholic cardiomyopathy with limited cardiac reserve. This problem can manifest after the donor heart is transplanted resulting in graft failure. We sought to investigate this possibility by reviewing our patients who underwent heart transplant with a heart from a donor with heavy alcohol use.

*Methods: Between 2010 and 2018, we assessed 53 heart transplant patients who received a donor with a history of heavy alcohol use (defined as 2+ drinks/day). These patients were compared to patients who received a donor without a history of heavy alcohol use (n=321). Patients with concomitant drug use were excluded from analysis. 1 year outcomes included survival, freedom from cardiac allograft vasculopathy (CAV), freedom from non-fatal major adverse cardiac events (NF-MACE: myocardial infarction, percutaneous coronary intervention/angioplasty, new congestive heart failure, pacemaker/implantable cardioverter-defibrillator placement, stroke), and freedom from rejection (any treated rejection (ATR), acute cellular rejection (ACR), antibody mediated rejection (AMR)). The incidence of severe primary graft dysfunction (PGD) was also recorded.

*Results: The donor heavy alcohol group compared to control had a trend for increased incidence of severe PGD and had a trend for lower freedom from NF-MACE. There were no significant differences between the two groups in survival, freedom from CAV, and freedom from all rejections.

*Conclusions: : A donor history of heavy alcohol use may be a risk factor for severe PGD and should be accepted with caution. However, larger numbers of patients are needed to confirm this observation.

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