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Safety and 1-Year Outcomes After Transplanting Hearts From SARS-CoV-2 Positive Donors: Insights From an International
Sabina P W Guenther1, Josephine Wadewitz2, Brian J Wayda3
1Clinic for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center North Rhine-Westphalia, Ruhr-University Bochum, Bad Oeynhausen, Germany.
Insights
Transplanting hearts from SARS-CoV-2 positive donors is safe, showing no difference in one-year survival or adverse cardiovascular events. This approach expands the donor pool for heart transplantation (HT).
Area of Science:
- Cardiology
- Virology
- Transplantation Immunology
Background:
- Uncertainties exist regarding the safety and efficacy of using hearts from SARS-CoV-2 positive donors for heart transplantation (HT).
- Assessing outcomes in international cohorts is crucial for establishing best practices in organ donation and transplantation.
Purpose of the Study:
- To evaluate the 1-year outcomes and safety of heart transplants utilizing organs from SARS-CoV-2 positive donors.
- To compare these outcomes against heart transplants from SARS-CoV-2 negative donors.
Main Methods:
- International retrospective analysis of heart transplants using SARS-CoV-2 positive donors in the US (UNOS registry) and Germany (DSO).
- Inclusion criteria: donors positive for SARS-CoV-2 within defined periods before organ recovery.
- Data collection focused on 1-year graft and recipient survival, acute rejection rates, rehospitalization, and specific adverse events.
Main Results:
- In the US, heart transplants from SARS-CoV-2 positive donors (n=274) showed lower acute rejection rates compared to negative donors (n=3952) (10.6% vs. 17.1%).
- One-year graft survival, recipient survival, and rehospitalization rates did not differ significantly between the groups.
- In Germany, recipients of SARS-CoV-2 positive hearts (n=23) had 91.3% one-year survival, with no cases of myocarditis or thromboembolism.
Conclusions:
- Selected SARS-CoV-2 positive donor hearts can be safely utilized for heart transplantation.
- Transplantation does not appear to increase the risk of SARS-CoV-2 transmission from donor to recipient.
- No significant differences in 1-year survival or adverse cardiovascular events were observed, supporting the expanded use of these organs.
Background:
Uncertainties persist regarding the utilization of hearts from SARS-CoV-2-positive donors for heart transplant (HT). This international study analyzed such HTs within the United States (US) and Germany, focusing on 1-year outcomes and granular safety data.
Methods:
Data was obtained from the United Network for Organ Sharing (UNOS) registry (03/2021-08/2022) and collaborating with the German Organ Procurement Organisation (DSO; 03/2022-02/2023). HTs from currently and recently (up to 21 days in UNOS and 90 days in DSO) SARS-CoV-2-positive donors were included.
Results:
In the US, 274 HTs from SARS-CoV-2 donors were analyzed (50.7% SARS-CoV-2-positive until organ recovery). Compared to 3952 HTs from SARS-CoV-2-negative donors, acute rejection was less frequent (10.6% vs. 17.1%, p = 0.006). One-year graft and recipient survival (p = 0.327) and rehospitalization rates (p = 0.592) did not differ. In Germany, 30 HTs utilized SARS-CoV-2-positive hearts. Follow-up was obtained for 23 (76.7%). 43.5% of the donors were positive until recovery. Two recipients (8.7%) tested positive for SARS-CoV-2 21 and 65 days post-transplant, both unlikely donor-derived. 8.7% had severe PGD, 8.7% acute cellular rejection ≥ 2R. One-year survival was 91.3%. None experienced myocarditis or thromboembolism.
Conclusion:
Using selected SARS-CoV-2-positive hearts for transplant appears safe with no differences in 1-year survival, no evidence of viral transmission or SARS-CoV-2-related adverse cardiovascular events.
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