One Year Outcomes Following Transplantation with COVID-19-Positive Donor Hearts: A National Database Cohort Study

Author:

Wolfe Stanley B.12,Singh Ruby1ORCID,Paneitz Dane C.13,Rabi Seyed Alireza1,Chukwudi Chijioke C.1ORCID,Asija Richa14,Michel Eriberto1,Ganapathi Asvin M.5,Osho Asishana A.1

Affiliation:

1. Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA

2. Department of Surgery, Allegheny General Hospital, Pittsburgh, PA 15212, USA

3. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD 21287, USA

4. Department of Surgery, Community Memorial Hospital, Ventura, CA 93003, USA

5. Division of Cardiac Surgery, Ohio State University Wexner Medical Center, Columbus, OH 43210, USA

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.

Publisher

MDPI AG

Subject

Pharmacology (medical),General Pharmacology, Toxicology and Pharmaceutics

Reference30 articles.

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3. American Society of Transplantation (2023, June 07). SARS-CoV-2 (Coronavirus, 2019-nCoV): Recommendations and Guidance for Organ Donor Testing. Available online: https://www.myast.org/sites/default/files/Donor%20Testing%20Document_07.07.21.pdf.

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5. Basu-Ray, I., Almaddah, N.k., Adeboye, A., and Soos, M.P. (2022, November 22). Cardiac Manifestations of Coronavirus (COVID-19), StatPearls, Available online: http://www.ncbi.nlm.nih.gov/books/NBK556152/.

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