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Evolving Long-Term Outcomes of Heart Transplantation Using COVID-19 Positive Donors
Ye In Christopher Kwon1, Brian Bao2, Jack Guiry2
1Division of Cardiothoracic Surgery, Department of Surgery, Pauley Heart Center, School of Medicine, Virginia Commonwealth University, Richmond, Virginia, USA.
Insights
Heart transplants using COVID-19+ donors show comparable long-term survival. Recent data indicates improved outcomes, suggesting these hearts are viable options, especially with donor vaccination considerations.
Area of Science:
- Cardiology
- Transplantation Immunology
- Infectious Diseases
Background:
- Evaluating donors with COVID-19 for heart transplantation (HT) is crucial as the virus becomes endemic.
- Assessing long-term outcomes of HT from COVID-19+ donors is important for clinical practice.
Purpose of the Study:
- To compare long-term survival and clinical outcomes between heart transplant recipients who received hearts from COVID-19+ donors versus COVID-19- donors.
- To analyze the impact of donor COVID-19 status on post-transplant complications and mortality.
Main Methods:
- Utilized the UNOS database to identify adult heart transplant recipients between April 2020 and September 2024.
- Stratified recipients based on donor COVID-19 status (positive nucleic acid or antigen test within 7 days of HT).
- Employed propensity score matching (3:1 ratio) and Cox regression models to analyze survival and mortality risk.
Main Results:
- No significant difference in 3-year survival, acute rejection, length of hospital stay, or postoperative stroke between COVID-19+ and COVID-19- donor groups.
- Higher rates of dialysis and primary graft dysfunction at 24 hours post-HT were observed in the COVID-19+ donor group.
- Recent HTs (2022-2024) from COVID-19+ donors showed decreased mortality risk, acute rejection, length of stay, and dialysis rates.
Conclusions:
- Heart transplants from COVID-19+ donors demonstrate adequate long-term outcomes, particularly in recent years.
- Donor COVID-19 positivity is not significantly associated with increased long-term mortality risk.
- Future research should investigate the impact of donor vaccination to further optimize survival benefits in heart transplantation.
Background:
As COVID-19 becomes endemic, evaluating COVID-19+ donors for heart transplantation (HT) remains important. We assessed long-term outcomes using national data and propensity-matched analysis.
Methods:
All adults (>18 years) undergoing HT between 4/2020 and 9/2024 were identified in the UNOS database. They were stratified into COVID-19+ versus -, defined by either a positive nucleic acid or antigen test within 7 days of HT. Groups were then 3:1 nearest propensity score matched. Survival was estimated by the Kaplan-Meier method. Mortality risk was assessed using Cox regression models.
Results:
A total of 879 recipients of COVID-19- hearts were matched with 293 recipients of COVID-19+ hearts. We found no significant differences in 3-year landmark survival between cohorts (p = 0.23). Rates of acute rejection (p = 0.15), length of hospital stay (LOS) (p > 0.9), and postoperative stroke (p = 0.53) did not differ significantly between groups. However, dialysis (17% vs. 12%, p = 0.04) and primary graft dysfunction rates at 24-h post-HT were significantly higher in COVID-19+ heart recipients (5.5% vs. 1.8%, p = 0.01). Donor COVID-19+ status was not significantly associated with mortality risk (HR 1.01, p = 0.66). COVID-19+ donor HTs in recent years (2022-2024) were associated with decreased mortality risk (HR 0.82, p = 0.02), rates of acute rejection (p < 0.001), LOS (p = 0.01), and dialysis (18% vs. 8.9%, p = 0.03).
Conclusions:
COVID-19+ hearts demonstrate adequate long-term outcomes, particularly in recent years. Future studies should assess the impact of donor vaccination to optimize survival benefits.
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