Heart transplantation in the era of corona virus disease 2019: Impact of the pandemic on donors, recipients and outcome.

Abstract

Since March 2020, the COVID-19 pandemic has tremendously impacted health care all around the globe. We analyzed the impact of the pandemic on donors, recipients, and outcome of heart transplantation (HTx). Between 2010 and early 2022, a total of n=235 patients underwent HTx in our department. Patients were assigned to the study groups regarding the date of the performed HTx. Group 1 (09/2010 to 02/2020): n=160, Group 2 (03/2020 to 02/2022): n=75. Since the pandemic, the etiology of heart failure in the recipients has shifted from dilated (Group 1: 53.8%, Group 2: 32.0%) to ischemic cardiomyopathy (Group 1: 39.4%, Group 2: 50.7%, p<.01). The percentage of high urgency status of the recipients dropped from 50.0% to 36.0% (p=.05), and the use of left ventricular assist (LVAD) support from 56.9% to just 37.3% (p<.01). Meanwhile, the waiting time for the recipients also decreased by about 40% (p=.05). Since the pandemic, donors were 2- times more likely to have been previously resuscitated (Group 1: 21.3%, Group 2: 45.3% (p<.01), and drug abuse increased by more than 3-times (p<.01), indicating acceptance of more marginal donors. Surprisingly, the incidence of postoperative severe primary graft dysfunction requiring extracorporeal life support decreased from 33.1% to 19.4% (p=.04) since the pandemic. The COVID-19 pandemic affected both donors and recipients of HTX but not the postoperative outcome. Donors nowadays are more likely to suffer from ischemic heart disease and are less likely to be on the high-urgency waitlist and on LVAD support. Simultaneously, an increasing number of marginal donors are accepted, leading to shorter waiting times.