Early Outcomes of Adult Heart Transplantation From COVID-19 Infected Donors

Shivank Madan; Marvyn Allen G Chan; Omar Saeed; Vagish Hemmige; Daniel B Sims; Stephen J Forest; Daniel J Goldstein; Snehal R Patel; Ulrich P Jorde

doi:10.1016/j.jacc.2023.04.022

Early Outcomes of Adult Heart Transplantation From COVID-19 Infected Donors

J Am Coll Cardiol. 2023 Jun 20;81(24):2344-2357. doi: 10.1016/j.jacc.2023.04.022. Epub 2023 May 17.

Authors

Shivank Madan¹, Marvyn Allen G Chan², Omar Saeed³, Vagish Hemmige⁴, Daniel B Sims³, Stephen J Forest⁵, Daniel J Goldstein⁵, Snehal R Patel³, Ulrich P Jorde³

Affiliations

¹ Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA. Electronic address: smadan@montefiore.org.
² Department of Medicine, Montefiore Medical Center, Bronx, New York, USA.
³ Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.
⁴ Division of Infectious Diseases, Department of Medicine, Montefiore Medical Center, Bronx, New York, USA.
⁵ Department of Cardiothoracic and Vascular Surgery, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.

Abstract

Background: There is a paucity of data on heart transplantation (HT) using COVID-19 donors.

Objectives: This study investigated COVID-19 donor use, donor and recipient characteristics, and early post-HT outcomes.

Methods: Between May 2020 and June 2022, study investigators identified 27,862 donors in the United Network for Organ Sharing, with 60,699 COVID-19 nucleic acid amplification testing (NAT) performed before procurement and with available organ disposition. Donors were considered "COVID-19 donors" if they were NAT positive at any time during terminal hospitalization. These donors were subclassified as "active COVID-19" (aCOV) donors if they were NAT positive within 2 days of organ procurement, or "recently resolved COVID-19" (rrCOV) donors if they were NAT positive initially but became NAT negative before procurement. Donors with NAT-positive status >2 days before procurement were considered aCOV unless there was evidence of a subsequent NAT-negative result ≥48 hours after the last NAT-positive result. HT outcomes were compared.

Results: During the study period, 1,445 "COVID-19 donors" (COVID-19 NAT positive) were identified; 1,017 of these were aCOV, and 428 were rrCOV. Overall, 309 HTs used COVID-19 donors, and 239 adult HTs from COVID-19 donors (150 aCOV, 89 rrCOV) met study criteria. Compared with non-COV, COVID-19 donors used for adult HT were younger and mostly male (∼80%). Compared with HTs from non-COV donors, recipients of HTs from aCOV donors had increased mortality at 6 months (Cox HR: 1.74; 95% CI: 1.02-2.96; P = 0.043) and 1 year (Cox HR: 1.98; 95% CI: 1.22-3.22; P = 0.006). Recipients of HTs from rrCOV and non-COV donors had similar 6-month and 1-year mortality. Results were similar in propensity-matched cohorts.

Conclusions: In this early analysis, although HTs from aCOV donors had increased mortality at 6 months and 1 year, HTs from rrCOV donors had survival similar to that seen in recipients of HTs from non-COV donors. Continued evaluation and a more nuanced approach to this donor pool are needed.

Keywords: COVID-19 donors; donor characteristics; heart transplantation; transplant outcomes.

MeSH terms

Adult
COVID-19*
Female
Heart Transplantation*
Humans
Male
Tissue Donors
Tissue and Organ Procurement*