Abstract 14448: Graft Loss and Rejection Following COVID in Pediatric Heart Transplantation - A Pediatric Heart Transplant Society (PHTS) Propensity Matched Analysis

Abstract

Introduction: While short-term outcomes following COVID among pediatric heart transplant (HT) recipients have been described, graft outcomes including the risks of subsequent graft loss and rejection following COVID are unknown. Hypothesis: We sought to determine the overall trends of post-HT survival during the COVID pandemic and determine if there was an increased risk for subsequent graft loss and/or rejection following post-HT COVID. Methods: All pediatric recipients of first HT between 1/2003-6/2022 in the Pediatric Heart Transplant Society ( PHTS) database were included. To assess if early post-HT survival changed during the COVID pandemic, 2-year HT survival was compared among those who underwent HT in 2014-2016, 2017-2019, and 2020-2022. To compare the risks of graft loss and rejection (acute cellular and/or antibody-mediated) between those with vs without post-HT COVID, a 1:2 (COVID vs non-COVID) propensity-score matched analysis using multiple pre-HT and post-HT factors (including exact matches for HT year and time post-HT) and Kaplan Meir analysis were performed. Patients with COVID within 3 months post-HT were excluded. Results: The 2-year post-HT survival was similar among patients who underwent HT across the 3 eras (Fig 1A). Among the overall 6634 patients (n = 888 [13%] with post-HT COVID), 861 patients with post-HT COVID and 1716 without post-HT COVID were included in propensity-score matching. There was no difference in the risk of subsequent graft loss (Fig 1B) or rejection (Fig 1C) among those with vs those without post-HT COVID. Conclusions: No differences were observed in early pediatric post-HT survival during the COVID pandemic compared to the immediately prior era. Post-HT COVID did not increase the risks of subsequent graft loss or rejection. Longer-term follow up is necessary to look at other potential post-HT COVID outcomes, such as coronary allograft vasculopathy.