Related Experiment Video
Updated: Jul 2, 2025
Lung Rapid Recovery Procurement Combined with Abdominal Normothermic Regional Perfusion in Controlled Donation after Circulatory Death
Published on: August 15, 2022
One Year Outcomes Following Transplantation with COVID-19-Positive Donor Hearts: A National Database Cohort Study
Stanley B Wolfe1,2, Ruby Singh1, Dane C Paneitz1,3
1Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Insights
Heart transplantation from donors positive for COVID-19 is safe, with similar survival rates and reduced rejection. This study analyzed early outcomes in COVID-19 positive donor heart recipients.
Area of Science:
- Cardiology
- Transplantation Immunology
- Infectious Diseases
Background:
- The safety of heart transplantation using donors positive for COVID-19 remains uncertain.
- Preliminary data suggests potential feasibility, necessitating further investigation.
Purpose of the Study:
- To evaluate the 1-year outcomes of heart transplant recipients receiving hearts from COVID-19 positive donors.
- To compare outcomes between recipients of COVID-19 positive and negative donor hearts using propensity matching.
Main Methods:
- Analysis of the Organ Procurement and Transplantation Network (OPTN) database for adult heart transplants (Jan 2020-Sep 2022).
- Definition of COVID-19 positive donors based on NAT or antigen tests within 21 days of procurement.
- 1:3 propensity score matching of 290 COVID-19 positive donor recipients with 870 COVID-19 negative donor recipients.
Main Results:
- No significant differences in survival at 30 days, 6 months, or 1 year between the groups.
- Recipients from COVID-19 positive donors showed significantly lower rates of postoperative acute rejection before discharge (p=0.01).
- Significant regional variation in the utilization of COVID-19 positive donor hearts was observed.
Conclusions:
- Heart transplantation from COVID-19 positive donors demonstrates safe early outcomes.
- Further research is required to confirm long-term outcome equivalence.
Abstract:
The current understanding of the safety of heart transplantation from COVID-19+ donors is uncertain. Preliminary studies suggest that heart transplants from these donors may be feasible. We analyzed 1-year outcomes in COVID-19+ donor heart recipients using 1:3 propensity matching. The OPTN database was queried for adult heart transplant recipients between 1 January 2020 and 30 September 2022. COVID-19+ donors were defined as those who tested positive on NATs or antigen tests within 21 days prior to procurement. Multiorgan transplants, retransplants, donors without COVID-19 testing, and recipients allocated under the old heart allocation system were excluded. A total of 7211 heart transplant recipients met the inclusion criteria, including 316 COVID-19+ donor heart recipients. Further, 290 COVID-19+ donor heart recipients were matched to 870 COVID-19- donor heart recipients. Survival was similar between the groups at 30 days (p = 0.46), 6 months (p = 0.17), and 1 year (p = 0.07). Recipients from COVID-19+ donors in the matched cohort were less likely to experience postoperative acute rejection prior to discharge (p = 0.01). National COVID-19+ donor heart usage varied by region: region 11 transplanted the most COVID-19+ hearts (15.8%), and region 6 transplanted the fewest (3.2%). Our findings indicate that COVID-19+ heart transplantation can be performed with safe early outcomes. Further analyses are needed to determine if long-term outcomes are equivalent between groups.
