Patterns and outcomes of COVID-19 donor utilization for heart transplant

Area of Science:

• Cardiology
• Transplantation Immunology
• Infectious Diseases

Background:

• The safety and efficacy of using donors positive for COVID-19 (CPD) in heart transplantation remain largely unknown.
• Assessing outcomes is crucial given the increased utilization of CPDs during the pandemic.

Purpose of the Study:

• To evaluate the short-term outcomes of heart transplantation utilizing COVID-19 positive donors (CPD) compared to COVID-19 negative donors.
• To determine if CPD utilization impacts recipient survival, rejection rates, or other post-transplant parameters.

Main Methods:

• A retrospective analysis of the UNOS database was conducted for heart transplants performed from the COVID-19 pandemic declaration until September 30, 2022.
• Donor and recipient demographics, pre-transplant characteristics, and post-transplant outcomes including survival, length of stay, and rejection episodes were compared between CPD and COVID-19 negative donor groups.

Main Results:

• Out of 9876 heart transplants, 177 (2.3%) utilized CPDs. No significant differences were observed in recipient demographics, pre-transplant support, waitlist times, or simultaneous renal transplant rates.
• Post-transplant, length of stay (16 vs. 17 days) and acute rejection episodes prior to discharge (3% vs. 8%) were comparable between groups.
• Short-term (90-day) survival (5% in both groups) and follow-up left ventricular ejection fraction (LVEF) were also similar, indicating no adverse impact from CPD utilization.

Conclusions:

• Active COVID-19 infection in heart donors does not appear to negatively affect short-term survival or rejection rates in recipients.
• The findings support the continued, judicious use of CPDs in heart transplantation, particularly when facing donor shortages.