Challenges in Heart Transplantation During COVID-19 Pandemic in Brazil

Abstract

PurposeA recent UNOS analysis comparing COVID-19 to pre-COVID-19 era found an increased waitlist inactivation, decreased waitlist addition, and decreased in numbers of heart transplant (HT). In Brazil, a pronounced negative effect on transplant was anticipated but has not been measured so far. Our objective was to evaluate the impact of COVID-19 pandemic on heart donation and HT.MethodsWe performed a descriptive analysis of data related to patients registered in HT waitlist and numbers of HT performed from March 2018 to August 2019 (pre-COVID era) and March 2020 to August 2021 (COVID era), by reviewing medical records and data from State Transplant System.ResultsA total of 221 patients were included in HT waitlist from 2018 to 2021. Approximately the same number of patients were listed in pre-COVID and COVID era (111 vs 110, respectively). Mean age of patients were 48.7 in the pre COVID and 48.9 years in the COVID era (p=0.91). The majority were listed as top priority criteria, 94 (85.5%) in COVID vs 100 (90.1%) in pre-COVID era, p=0.293, mostly due to mechanical circulatory assist devices ECMO and Centrimag (10.9% vs 18%), and intra-aortic balloon pump (41.8 % vs 39.6%) respectively, p=0.496. There was no difference in the survival of patients in waitlist (p = 0.226). Regarding number of HT, we observed highest absolute number of surgeries in the pre-COVID era (78 vs 66), with no statistical significance (p=0.109). There was no difference between the deaths after HT, 17 (15.3%) in pre-COVID and 9 (8.2%) in COVID era, p=0.249. During the peak of number of COVID-19 cases in Brazil (may-july 2020 and february-april 2021) we observe a reduction in overall heart transplant procedures an inclusion in waitlist (figure).ConclusionTo the best of our knowledge, this is the first report of the impact of COVID - 19 on solid organ donation and HT. There were no differences between number of patients included in HT waitlist and outcomes after HT before and during COVID. However, there was a decrease in number of HT and inclusion in HT waitlist during the peak of COVID-19.