Transplant patients who receive a heart from a COVID-19–infected donor may be at greater risk for death at 6 months and 1 year, finds a study published yesterday in the Journal of the American College of Cardiology.
Researchers from Montefiore Medical Center and the Albert Einstein College of Medicine identified 27,862 donors in the United Network for Organ Sharing who underwent COVID-19 testing and had data on organ disposition from May 2020 to June 2022. Donors were tested multiple times before procurement.
Donors were considered to have COVID-19 if they tested positive during hospitalization and then were subclassified as having active infection if they tested positive within 2 days of organ procurement or having recently resolved COVID-19 if they tested positive and then negative before procurement.
There is no clear consensus on the evaluation and use of COVID-19 donor hearts for transplant, the authors said.
Double the risk of death at 1 year
Of the 1,445 COVID-19 donors, 1,017 had active infections, and 428 had recently resolved cases. A total of 309 heart transplants used organs from COVID-19 donors, and 239 (150 with active infections and 89 with recently resolved cases) met the study criteria. Relative to uninfected donors, those with COVID-19 were younger, and about 80% were male.
Recipients of organs from donors with active COVID-19 infections had a higher death rate than recipients of hearts from uninfected donors at 6 months (7% vs 13.8%; hazard ratio [HR], 1.74; 95% confidence interval [CI] 1.02 to 2.96; P = 0.043) and 1 year (23.2% vs 9.2%; HR, 1.98; 95% CI, 1.22 to 3.22; P = 0.006), while recipients of organs from uninfected and recently resolved donors had similar death rates at 6 months (7% vs 8.5%) and 1 year (9.2% vs 13.6%, respectively).
These early trends should be concerning enough.
The researchers noted that SARS-CoV-2 can cause endothelial (cell layer lining blood vessels) dysfunction and heart damage that may not be detected before transplant.
"These early trends should be concerning enough such that heart transplantation centers need to thoroughly evaluate and continue to weigh the risks/benefits of using hearts from active COVID-19 donors," lead author Shivank Madan, MD, MHA, said in an American College of Cardiology news release.