Abstract
Introduction: Small institutional case series have documented successful heart transplant outcomes using COVID-19 positive (COVID-19+) donor allografts. However, little is known regarding the impact of donor COVID-19 status on a national scale. In this study, we characterize outcomes of the first 84 COVID-19+ donor heart transplants in the United States. Methods: Retrospective analysis of the United Network for Organ Sharing database was performed for adult heart transplants from February 2021 to March 2022. Donor COVID-19+ status was defined as a positive nucleic acid amplification, antigen or other COVID-19 test within 7 days of transplant. Fisher’s exact test and Kaplan-Meier survival estimates were used to determine differences in outcomes, including graft failure, post-operative stroke and dialysis, length of stay and 30-day survival. Results: Overall, 3,289 heart transplants were included in analysis, with 84 utilizing COVID-19+ donor hearts. COVID-19+ allografts had similar cold ischemic times (3.7 vs 3.5 hours, P=0.22) compared to others. Recipients of COVID-19+ donor organs had similar lengths of stay (15 vs 17 days, P=0.19), rates of graft failure (2.4% vs 1.0%, P=0.22), post-operative stroke (0.0% vs 3.0%, P=0.18), post-operative dialysis (15.5% vs 13.4%, P=0.52) and 30-day post-transplant survival (96.1% vs 97.0%, P=0.63) compared to recipients of non-positive donors. Among the 4 deceased recipients of COVID-19+ allografts, none have died from pulmonary or infectious causes of death. Use of COVID-19+ donors for heart transplantation increased throughout the study period (r=0.79, Figure). Conclusions: Short-term outcomes of heart transplant recipients receiving COVID-19+ donor organs are reassuring, providing preliminary evidence that heart transplantation may be safely performed using appropriately selected COVID-19+ donor allografts. Continued monitoring for long-term outcomes and potential complications are warranted.
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