A recent study soon to be presented at the American Heart Association (AHA) Scientific Sessions 2022* suggests that hearts from coronavirus disease 2019 (COVID-19)-positive (COVID-19+) donors may be safe for transplantation.
Small case series have shown the success of heart transplantation from COVID-19+ donors, but the impact of COVID-19 status of the donor is not known at a national level. The guidelines from the Heart Failure Society of America, the American College of Cardiology, and AHA for managing heart failure recommend transplantation for those progressing to advanced heart failure (stage D).
Advanced heart failure patients experience severe symptoms such as swelling, fatigue, and shortness of breath. These symptoms interfere with daily activities and may cause recurrent hospital admissions despite optimal medical therapies. According to AHA’s Heart Disease and Stroke Statistics, heart transplant demand has doubled in the last three decades. More than 3000 individuals are now waiting for heart transplantation in the United States (US).
Study: Outcomes of COVID-19 Positive Donor Heart Transplantation in the United States. Image Credit: Maksim Shmeljov / Shutterstock
The study and findings
In the present study, researchers characterized the outcomes of the first COVID-19+ donor heart transplants in the US. They retrospectively analyzed the United Network for Organ Sharing database for adult heart transplants between February 2021 and March 2022. The COVID-19+ positive status of donors was defined as a positive antigen, nucleic acid amplification, or other tests within seven days of transplantation.
The differences in outcomes, such as graft failure, length of stay in the hospital, postoperative complications (dialysis or stroke), and 30-day survival, were assessed using Kaplan-Meier survival estimates and Fisher’s exact test. The present analysis included 3,289 heart transplant cases, including 84 COVID-19+ donors.
Cold ischemic times were similar between COVID-19+ allografts and others. The average length of hospitalization was 15 days for recipients of COVID-19+ allografts compared to 17 days for patients receiving the organ from a non-COVID-19+ donor. Graft rejection was recorded in 2.4% of COVID-19+ allograft recipients compared to 1% in others.
The 30-day survival rate was similar between patients receiving a heart from COVID-19+ donors (96.1%) and non-COVID-19+ donors (97%). The rates of postoperative complications, such as dialysis and stroke, were similar between the two groups. Four recipients of COVID-19+ allografts died, with none from infectious or pulmonary causes. Notably, the use of COVID-19+ allografts increased throughout the study.
The short-term outcomes of transplant cases receiving a heart from COVID-19+ donors are encouraging. The study provided preliminary evidence that heart transplantation could be safe using appropriate allografts from COVID-19+ donors. The small sample size may limit the impact of the findings, and the study may be underpowered to identify differences in heart transplant experiences. Further monitoring is warranted for long-term outcomes and potential outcomes.
Statements and conclusions of studies that are presented at the American Heart Association’s scientific meetings are solely those of the study authors and do not necessarily reflect the Association’s policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. Abstracts presented at the Association’s scientific meetings are not peer-reviewed, rather, they are curated by independent review panels and are considered based on the potential to add to the diversity of scientific issues and views discussed at the meeting. The findings are considered preliminary until published as a full manuscript in a peer-reviewed scientific journal.