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

Abstract

Background The outcomes following COVID‐19 positive donor (CPD) utilization for heart transplant are unknown. Methods UNOS database was analyzed for heart transplants performed from the declaration of COVID‐19 pandemic until September 30, 2022. Result Since the onset of pandemic, there were 9876 heart transplants reported. COVID‐19 antigen or NAT results were available in 7698 adult donors within 14 days of donation, of which 177 (2.3%) were positive. There was no difference in recipient demographics, including age (COVID positive donor vs. negative: 55 vs. 56 years, p = .2) and BMI. Listing status 1 and 2 were similar in both groups (7% vs. 10% and 48% vs. 49% respectively, p = .4). Durable and temporary mechanical support were similar in both groups pre‐transplant (both groups 33%, p = .9). There was no difference in days on the waitlist (median 31 days, p = .9). Simultaneous renal transplant rates were similar (11% vs. 10%, p = .9). CPD utilization has increased since the onset of the pandemic, and the adoption is present across most UNOS regions. Post‐transplant, there was no difference in length of stay (median 16 vs. 17 days, p = .9) and acute rejection episodes prior to discharge (3% vs. 8%, p = .1). In survival analysis of 90‐day follow up, number of deaths reported were comparable (5% in both groups, p = .9) Follow‐up LVEF was comparable (62% vs. 60%, p = .4). Conclusion Active COVID‐19 infection in donors did not affect survival or rejection rates in the short‐term post‐heart transplant.

Successful heart transplantation from a COVID‐19‐positive donor: A clinical case report

“…the number of available donor hearts, reduce waiting periods, and improve survival rates for patients waiting for heart transplants. 4,5 Based on recent updates in Recommendations and Guidance for Organ Donor Testing and Evaluation, non-lung donors are accepted as heart donors because of the low possibility of transmission of infection. 6 Samuel T. Kim and his colleagues declared that there was no significant difference between in-hospital, 30-day, and cumulative death in positive COVID-19 and nonpositive COVID-19 heart donors.…”

“…Even after the World Health Organization (WHO) declaration about the end of the COVID‐19 pandemic, new variants are still emerging. According to previous studies, SARS–CoV–2‐positive donor hearts are known to increase the number of available donor hearts, reduce waiting periods, and improve survival rates for patients waiting for heart transplants 4,5 . Based on recent updates in Recommendations and Guidance for Organ Donor Testing and Evaluation, non‐lung donors are accepted as heart donors because of the low possibility of transmission of infection 6…”

Covid‐19 positive donor utilization for heart transplantation: The new frontier for donor pool expansion

“…3 " We have recently described that utilization of CPD hearts did not have additional adverse outcomes post-transplant in a short follow-up period. 4 It was noted in the UNOS registry study that, during a 90-day follow up, the number of deaths reported (5% in both groups, p = .9) and follow-up LVEF were comparable (p = .4) between COVID positive and negative donor heart recipients. 4 A similar result was noted in another simultaneously published paper.…”

“…4 It was noted in the UNOS registry study that, during a 90-day follow up, the number of deaths reported (5% in both groups, p = .9) and follow-up LVEF were comparable (p = .4) between COVID positive and negative donor heart recipients. 4 A similar result was noted in another simultaneously published paper. 5 A recently published paper distinguished donors based on active COVID-19 infection (defined as donors with a positive test within 2 days of organ procurement) and those with recently resolved COVID-19 infection in a UNOS registry study.…”

“…Hearts from CPD have been being utilized for transplant consistently since January 2021, with a comparable survival at 3 months. 4 In fact, CPD utilization seems to account for similar transplant rates compared to HCV and DCD. However, our understanding of CPD utilization has several gaps.…”