Donor hearts in COVID patients linked to lower survival

May 23, 2023 – People who receive a heart transplant from a donor who had active COVID-19 New research has found that heart transplant recipients have a higher risk of dying within 6 months and after 1 year than those who receive hearts from non-Covid patients.

“These early trends should be sufficiently concerning that heart transplant centers should carefully evaluate and continue to weigh the risks/benefits of using hearts from active COVID-19 donors.” Cardiac Therapy at Montefiore Medical Center/Albert Einstein College of Medicine in New York, the statement said.

The study was for online publication on May 17 a Journal of the American College of Cardiology.

A developing problem

COVID can cause early signs of heart disease and heart damage in potential donors. Currently, there is no clear consensus regarding the evaluation and use of COVID-19 donors for heart transplantation.

Previous data two small studies showed similar short-term outcomes in patients who received hearts from donors with COVID and those who did not.

For this analysis, researchers identified 27,862 donors in the United Network for Organ Sharing (UNOS) database between May 2020 and June 2022 who underwent nearly 61,000 highly sensitive and accurate COVID tests.

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Donors were considered to be COVID donors if they tested positive at any time during their hospital stay. Active COVID status was given to those who tested positive within 2 days of organ removal, and recently resolved COVID status was given to those who tested positive for the first time but became negative before heart donation.

Of the 1,445 COVID donors, 1,017 were classified as active and 428 were recently resolved. A total of 239 adult heart transplants met the study criteria (150 with active infection and 89 recently resolved).

Heart transplants from active COVID-19 donors were associated with a higher risk death At 6 months and 1 year, compared to heart transplantationtion not from a COVID donor.

Mortality rates at 6 months and 1 year were 13.8% and 23.2%, respectively, for those who received active COVID-19 donor hearts, compared with 7 and 9.2%, respectively, for those who received non-COVID-19 donor hearts.

The 6-month and 1-year mortality rates were similar for heart transplants from recently recovered and non-COVID donors.

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It calls for caution and more data

“The current study highlights the importance of ongoing evaluation and the likely need for a more nuanced approach to utilizing the 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 assess the outcome of the disease. [heart transplants] From donors infected with COVID-19,” they said.

According to Sean Pinney, MD, chief of cardiology at Mount Sinai Morningside in New York, this “careful analysis warrants caution in accepting hearts from donors with active or recent COVID-19 infection.”

He agrees with the researchers that more research is needed. “Although there appears to be a sign of harm, I do not think it is wise to draw too many conclusions from the data presented. This analysis cannot provide details about the mechanisms that may explain the observed increase in mortality,” Pinney said. .

“It is curious that the evidence of damage does not appear until more than 3 months after transplantation. Furthermore, we do not know the immunization status of these recipients and how vaccination may affect the results,” he said.

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Heart transplant programs must continue to carefully weigh the pros and cons of using these donor organs, “keeping in mind that transplant candidates who remain on the list have a very high chance of dying. It is still in their best interest to use an organ carefully selected from a COVID-19 patient,” he said. Pinney.

Alex Reyentovich, MD, medical director of NYU Langone Heart’s heart transplant program, cautioned that the study lacked “granular” data on the amount of virus in the COVID donors.

A donor may have a higher or lower level of the virus, but “this study does not reach that level [detail],” he said.

“THE an active COVID-infected donor is someone none of us would likely hire. But someone with positive COVID test and very low [amount of virus]that’s somebody I think most centers would take,” Reyentovich said.

“Hopefully in the future this will become less of an issue and we can stop making these types of decisions,” he said.