May 23, 2023 – People who receive a heart transplant from a donor who had active COVID-19 have a higher risk of dying at 6 months and 1 year later, compared to those who receive a heart from patients without COVID, according to new research.
“These early trends should be concerning enough that heart transplant centers need to thoroughly evaluate and continue to weigh the risks/benefits of using hearts from active COVID-19 donors,” said lead researcher Shivank Madan, MD. , cardiologist at the Center for Advanced Cardiac Therapy at Montefiore Medical Center/Albert Einstein College of Medicine in New York City, said in a statement.
The study was published online May 17 in the Journal of the American College of Cardiology.
COVID can cause early signs of heart disease and heart damage in potential donors. Currently, there is no clear consensus on the evaluation and use of COVID-19 donors for heart transplants.
Previous data Two small studies suggested similar short-term outcomes in patients who received hearts from donors with COVID and those who did not.
For this analysis, the researchers identified 27,862 donors in the United Network for Organ Sharing (UNOS) database, between May 2020 and June 2022, who had undergone nearly 61,000 highly sensitive and accurate tests for COVID.
Donors were considered COVID donors if they tested positive at any time during their hospital stay. Active COVID status was assigned to those who tested positive within 2 days of organ retrieval, and recently resolved COVID status was assigned to those who tested positive early but became negative before the gift of heart.
Of the 1,445 COVID donors, 1,017 were classified as active cases and 428 as recently resolved. Overall, 239 adult heart transplant recipients met study criteria (150 with active infection and 89 with recently resolved infection).
Heart transplants from an active COVID-19 donor were linked to a higher risk of death at 6 months and 1 year, compared to heart transplantationation from a non-COVID donor.
The 6-month and 1-year mortality rates were 13.8% and 23.2%, respectively, for those who received hearts from active COVID-19 donors versus 7% and 9.2%, respectively, for those who received hearts from non-COVID-19 donors.
Mortality rates at 6 months and 1 year were similar for heart transplants from recently recovered and non-COVID donors.
Calls for caution and more data
“The current study highlights the importance of ongoing assessment and likely the need for a more nuanced approach to utilizing this new group of donors,” the researchers said..
“Further studies with larger numbers of patients, longer follow-up and more detailed clinical data are needed to assess the results of [heart transplants] from donors infected with COVID-19,” they said.
Sean Pinney, MD, chief of cardiology at Mount Sinai Morningside in New York, said this “carefully performed analysis raises a caveat about accepting hearts from donors with active or recent COVID-19.”
He agrees with the researchers that more research is still needed. “While there appears to be a signal of harm, I think it is unwise to draw too many conclusions from the data as presented. This analysis is unable to provide details on the mechanisms that might explain the observed increase in mortality,” Pinney said. .
“It is curious that a signal of harm does not appear until more than 3 months after transplantation. Moreover, we do not know the vaccination status of these recipients and how vaccination may impact the results”, a- he declared.
Heart transplant programs must continue to carefully weigh the pros and cons of using these donor organs, “bearing in mind that transplant candidates who remain on the list are at very high risk of dying. Using a carefully selected organ from a COVID-19 patient may always be in their best interests,” Pinney said..
Alex Reyentovich, MD, medical director of the heart transplant program at NYU Langone Heart, cautioned that the study lacks “granular” data on the amount of virus in COVID donors.
A donor may have higher or lower levels of virus in their system, but “this study does not address that level of [detail],” he said.
“A donor with an active COVID infection is someone none of us would likely take. But someone with a positive COVID test and a very low [amount of virus]he’s someone I think most centers would take,” Reyentovich said.
“Hopefully in the future it will become less and less of a problem and we can stop making these kinds of decisions,” he said.