May 23, 2023 – People who receive a heart transplant from a donor who has had COVID-19 have New research shows there may be a better risk of death after six months and one 12 months in comparison with those that receive a heart from a non-COVID patient.
“These early trends should be of such concern that heart transplant centers must carefully evaluate and continue to weigh the risks and benefits of using hearts from active COVID-19 donors,” lead investigator Shivank Madan, MD, a cardiologist on the Center for Advanced Cardiac Therapy at Montefiore Medical Center/Albert Einstein College of Medicine in New York City, said in an announcement.
The study was published online 17 May in Journal of the American College of Cardiology.
Evolving problem
COVID could cause early signs of heart disease and heart damage in potential donors. There is currently no clear consensus on the evaluation and use of COVID-19 donors for heart transplants.
Previous data Results from two smaller studies suggest that there have been similar short-term outcomes in patients who received hearts from donors who had COVID and those that didn’t have COVID.
For this evaluation, researchers identified 27,862 donors within 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 in the event that they tested positive at any time during their hospital stay. Active COVID status was given to those that tested positive inside 2 days of organ donation, and recently recovered COVID status was given to those that initially tested positive but became negative before heart donation.
Of the 1,445 COVID donors, 1,017 were classified as energetic cases and 428 as recently recovered cases. A complete of 239 adult heart transplant recipients met the standards for the study (150 with energetic infection and 89 with recently recovered).
Heart transplants from an energetic COVID-19 donor were related to a better risk Death after 6 months and 1 12 months in comparison with heart transplantationation from a non-COVID donor.
Mortality rates at six months and one 12 months were 13.8% and 23.2%, respectively, for many who received energetic COVID-19 donor hearts, versus 7% and 9.2%, respectively, for many who received non-COVID-19 donor hearts.
Mortality rates at 6 months and 1 12 months were similar for heart transplants from recently recovered and non-COVID donors.
Call for caution and more data
“The current study highlights the importance of continuous evaluation and probably the need for a more differentiated approach in using this new donor pool,” the researchers said..
“Further studies with a larger number of patients, longer follow-up and more detailed clinical data are needed to confirm the results of [heart transplants] from COVID-19 infected donors,” they said.
Sean Pinney, MD, chief of cardiology at Mount Sinai Morningside in New York City, said this “careful analysis warrants caution in accepting hearts from donors with active or recent COVID-19 disease.”
He agrees with the researchers that more research is needed. “Although there appears to be evidence of a risk, I think it would be unwise to draw too many conclusions from the available data. This analysis cannot provide details about the mechanisms that might explain the observed increase in mortality,” Pinney said.
“It is strange that any sign of damage does not appear until more than three months after transplantation. In addition, we do not know the immunization status of these recipients and do not know how vaccination might affect the outcomes,” he said.
Heart transplant programs should continue to carefully weigh the pros and cons of using these donor organs, “keeping in mind that transplant candidates who remain on the list are at very high risk of death. Using a carefully selected organ from a COVID-19 patient may still be in their best interest,” Pinney said..
Alex Reyentovich, MD, medical director of the heart transplant program at NYU Langone Heart, cautioned that the study lacked “granular” data on the quantity of virus in COVID donors.
A donor could have higher or lower levels of virus of their system, but “this study does not address that level. [detail],” he said.
“A A donor with an active COVID infection is someone none of us would probably take. But someone with a positive COVID test and a very low [amount of virus]that's someone most centers would take, I think,” Reyentovich said.
“Hopefully this will be less and less of a problem in the future and we can stop making such decisions,” he said.