COVID-19 Positive Donor Hearts Lower Survival in Transplant Patients

An analysis of data from donors suggests donor hearts from patients who were COVID-19 positive could place transplant patients at increased risk of mortality.

A red flag related to the potential impact of using COVID-19-positive donor hearts on post-transplant survival is raised by a study from investigators at the Albert Einstein College of Medicine. The study results were published in the Journal of the American College of Cardiology.

By 2023, the COVID-19 pandemic has impacted lives across the globe. According to the US Centers for Disease Control and Prevention (CDC), COVID-19 has been responsible for more than 6 million total hospitalizations and more than 1.1 million deaths in the US since the pandemic began.

Impact Of COVID-19 Pandemic On Organ Transplantation

Although headlines related to COVID-19 have been innumerable in both magnitude and the different subject areas examined, a consistent theme in much of the coverage has been the impact on long-term health, including cardiovascular health.

Coronavirus
Coronaviruses infect animals, humans, and birds. Human coronaviruses, such as SARS, MERS, and 2019-nCoV cause respiratory distress and even death. The S protein is the infectious agent of the virus.

‘Heart transplantation centers need to thoroughly evaluate and continue to weigh the risks/benefits of using hearts from active COVID-19 donors.’

The COVID-19 pandemic also presented challenges for heart transplantation since transplant centers had to continuously modify their recipient and donor management protocols as the pandemic and understanding of the virus evolved (). There continues to be a lack of data on the long-term outcomes of transplants from COVID-19-infected donors, especially as new virus variants emerge.

Therefore, researchers from the Montefiore Medical Center of the Albert Einstein College of Medicine examined the characteristics and outcomes of heart transplants using hearts from COVID-19 donors relative to those from donors without COVID-19.

The study looked at more than 27,000 donors in the United Network for Organ Sharing (UNOS) between May 2020 and June 2022; in total, donors were given more than 60,000 COVID-19 tests before organ procurement. Donors were considered COVID-19 donors if they tested positive at any time during terminal hospitalization.

COVID-19 Positive Donor Hearts May Impact Post-Transplant Survival

Active COVID-19 status was given to those who tested positive within two days of organ procurement and recently resolved COVID-19 status was given to those who tested positive initially but became negative before procurement.

Heart Transplant Paradox: Long Waiting List but Declining Donor Heart Acceptance by Hospitals
A new study indicates that the acceptance of donor hearts has declined from 44% to 29% in 10 years, despite the increase in heart transplant waiting list and more patients dying on the list.

Of the donors in UNOS, 1,445 were identified as COVID-19 donors, of which 1,017 were classified as active COVID-19 donors and 428 were recently resolved COVID-19 donors. Overall, 309 heart transplants used COVID-19 donors, and 239 of those met the study criteria.

Those receiving heart transplants from active COVID-19 donors had an increased risk of mortality at six months and one year (7% vs 13.8% at six months and 9.2% vs. 23.2% at one year for non-COVID-19 vs. active COVID, respectively) ().

Keeping the Donor Heart Alive Makes Heart Transplantation Feasible
Donation after circulatory death (DCD) based heart transplantation based can increase hearts available for transplantation, contributing to the health-care systems.

Those receiving transplants from recently resolved COVID-19 donors had similar six-month and one-year mortality rates as those receiving transplants from non-COVID donors (7% vs. 8.5% at six months and 9.2% vs. 13.6% at one year for non-COVID vs. recently resolved COVID, respectively).

Researchers also found that during the study period, there was an increasing use of COVID-19 donors but transplant centers were selective and mostly used donors who were younger and about 80% were male.

Inclusive Approaches to Heart Transplants Seek Success
Expansion of heart transplant procedures accepted hearts from older donors with additional medical conditions and also transplant recipients suffering with severe illnesses at Yale New Haven Hospital.

Also, potential donors were tested for COVID-19 multiple times before organ procurement, with those who had at least one positive test receiving subsequent tests more often than those who tested negative the first time ().

Limitations of the study include variation in the timing and frequency of COVID-19 testing during terminal hospitalization and lack of information on COVID-19 disease activity, including Ct values to indicate viral load, date of disease onset and symptom burden, or vaccination status of donor or recipient.

The authors also emphasized that this is still early data, and continued evaluation of COVID-19 donors with a larger sample size, longer follow up and newer variants of COVID-19 is needed.

References:

Global Impact of the COVID-19 Pandemic on Solid Organ Transplant - (https://www.sciencedirect.com/science/article/pii/S0041134522001324?via%3Dihub )
Organ donation during the COVID-19 pandemic - (https://www.amjtransplant.org/article/S1600-6135(22)21554-8/fulltext )
Early Outcomes of Adult Heart Transplantation From COVID-19 Infected Donors - (https://www.sciencedirect.com/science/article/pii/S0735109723054621?via%3Dihub )

Source-Eurekalert