Hearts from SARS-CoV-2-positive donors safe for transplant
Adults who received heart transplants from SARS-CoV-2-positive donors experienced similar 30-day and 1-year outcomes compared with recipients of SARS-CoV-2-negative hearts, according to a registry analysis.
Heart transplant rates and additions to the waitlist decreased during the pandemic, in part because of concerns surrounding use of allografts from SARS-CoV-2-positive donors, Clancy W. Mullan, MD, a resident at Yale New Haven Hospital, and colleagues wrote in a research letter in JACC: Heart Failure. Additionally, the extent of cardiac injury after mild SARS-CoV-2 infection is an active area of investigation.
“Although clinical evidence of cardiac injury is rare in otherwise healthy, young, infected persons, endothelial dysfunction and subcellular derangements could theoretically have longer-term consequences for a mild or subclinical infection in the transplanted organ,” Mullan and colleagues wrote.
Mullan and colleagues analyzed data from patients who underwent a heart transplant from March 2020 to December 2021. Researchers identified recipients of organs from SARS-CoV-2-positive donors and compared them with recipients of SARS-CoV-2-negative donors. The primary outcome of interest was patient posttransplantation mortality.
Researchers identified 32 recipients of organs from SARS-CoV-2-positive donors and compared them with 5,445 recipients of allografts from SARS-CoV-2-negative donors during the same period. Survival at 30 days and 1 year was 100% for the recipients of organs from SARS-CoV-2-positive donors and there were no apparent differences in short-term survival compared with recipients of organs from SARS-CoV-2-negative donors (P = .342 at 30 days; P = .218 at 1 year).
Compared with declined donors, the accepted organs came from donors who were younger (median age, 28 vs. 47 years; P < .001), less likely to be women (8.1% vs. 39.1%; P = .002) and of lower BMI (median, 27 kg/m2 vs. 31.6 kg/m2; P = .001). Accepted hearts had higher ejection fraction (median, 64% vs. 60%; P = .04) and were less likely to be donated after circulatory death (8.1% vs. 56.4%; P < .001), according to the researchers.
The researchers noted there was no data on COVID-19 symptomatology of the donors or its temporal relation to organ retrieval; however, data were “encouraging” that short-term survival was similar for recipients of organs from SARS-CoV-2-positive and SARS-CoV-2-negative donors.
“The question of whether to accept hearts from SARS-CoV-2-positive donors is an important ethical dilemma that needs to be addressed promptly,” the researchers wrote. “As patients languish on organ waitlists without viable alternatives and thousands of new SARS-CoV-2 diagnoses are made daily in the United States alone, transplant clinicians and centers have a duty to discuss the potential risks and benefits of transplantation clearly and openly from a SARS-CoV-2 test positive donor vs. the risk of continued waiting.”
Collapse
Read more about