The Perfect Enemy | Hearts from COVID-19-positive donors may be safe for transplantation
December 1, 2022

Hearts from COVID-19-positive donors may be safe for transplantation

Hearts from COVID-19-positive donors may be safe for transplantation  Healio

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November 23, 2022

3 min read

Source:

Kim ST, et al. Abstract 563. Presented at: American Heart Association Scientific Sessions; Nov. 5-7, 2022; Chicago (hybrid meeting).

Disclosures:
Kim reports no relevant financial disclosures.

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CHICAGO — Short-term outcomes in heart transplant recipients who received hearts from people who were COVID-19 positive are “reassuring,” researchers reported at the American Heart Association Scientific Sessions.

Samuel T. Kim, BA, medical student at the David Geffen School of Medicine at UCLA, and colleagues presented outcomes of the first 110 COVID-19-positive donor heart transplants in the United States.

Graphical depiction of source quote presented in the article

“We found that patients receiving hearts from COVID-19-positive donors experienced similar rates of death in the hospital and at 30 days following transplantation, as well as similar rates of complications such as graft failure and lung complications. Thus, we found preliminary evidence based on national data that COVID-19-positive donor hearts may be safely and effectively used for heart transplantation without adverse short-term effects,” Kim told Healio.

Short-term outcomes

The researchers performed a retrospective analysis of the United Network for Organ Sharing (UNOS) database of single-organ adult heart transplants performed in the U.S. from January 2020 to March 2022.

“Heart transplantation remains the gold standard treatment for end-stage heart failure in the U.S. Despite the increased need for this operation, a continued challenge is the shortage of available donor organs for people in need of transplantation. With the onset of the COVID-19 pandemic, there is an increased rate of donors testing positive for COVID-19, which generally renders the donors unsuitable for transplantation. Several institutions have started to use COVID-19-positive donor hearts for heart transplantation in recent months and have reported good outcomes. However, it is unclear what the outcomes of COVID-19-positive donor heart transplantation are at the national level,” Kim told Healio.

Use of COVID-19-positive donor hearts increased during the study period. Most of the COVID-19-positive donor heart transplants occurred in the Southeast, Mid-Atlantic and Midwest U.S., according to the results.

Recipients of COVID-19-positive donor hearts were younger (54 vs. 57 years) than those who received COVID-19-negative hearts, but there were similar rates of women (24% vs. 27%) and “non-white” race (38% vs. 39%) recipients, according to the results.

The researchers then performed nearest-neighbor propensity score matching with 100 matched pairs of recipients of COVID-19-positive donor hearts compared with non-positive hearts and found that differences in short-term outcomes between the groups were not significant:

  • 30-day mortality was 3% in both groups (P = .99);
  • 3-month survival was 88% vs. 94% (P = .23);
  • rate of graft failure was 1% vs. 0% (P = .99);
  • postoperative stroke occurred in 1% in each group (P = .99);
  • postoperative dialysis was needed in 14% vs. 11% (P = .52); and
  • length of stay was 15 days in both groups (P = .4).

To date, eight recipients of COVID-19-positive donor hearts died. In these patients, pulmonary and infectious causes of death were rare, according to the researchers.

“We were surprised by our findings, as we would expect that the presence of COVID-19 in a donor would cause differences in outcomes upon transplantation in the recipient. Specifically, we would expect death from respiratory causes to presumably be a major problem in recipients receiving donors with COVID-19. However, in our study, we found no differences in outcomes between the groups,” Kim told Healio.

Continued monitoring warranted

Several case series have documented safe and effective use of COVID-19-positive organs for heart transplantation, Kim said.

“However, nationally representative analyses on the safety and efficacy of COVID-19-positive donor heart transplantation are lacking,” Kim said. “Our study is the first to report on the national outcomes of COVID-19-positive donor hearts in heart transplantation and uses the largest sample size to date.”

However, Kim said, there remains limited data on long-term outcomes of recipients of COVID-19-positive hearts.

“The concern may be that while COVID-19-positive donor organs may not confer a short-term risk in recipients, long-term outcomes may be compromised, which this study can’t rule out due to the short time period of COVID-19-positive donor organ transplantation in the U.S.,” Kim said.

The researchers concluded that future research should focus on continued monitoring for long-term outcomes and potential complications.

“These findings may provide evidence that we can be more aggressive about accepting donors that are positive for COVID-19 when patients are in dire need of an organ for heart transplantation. This may help to address organ shortages in heart transplantation, given the large number of donors positive for COVID-19. This also may provide evidence that the increased risk, if any, of using an asymptomatic COVID-19-positive donor for heart transplantation is most likely ameliorated by having a timelier operation with less time awaiting a heart on the recipient end,” Kim said.

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