Abstract
PURPOSE: Coronavirus disease 2019 (COVID-19) causes a profound systemic inflammatory response and the transmissibility was unknown early in the pandemic; consequently, transplant centers were hesitant to utilize organs from COVID-19+ donors. This study aims to analyze short and medium-term outcomes in recipients of hearts from COVID-19+ donors. METHODS: The Organ Procurement and Transplantation Network database was queried for all heart transplant recipients between January 1, 2020 and December 31, 2021. Recipients of COVID-19+ donor hearts were compared to recipients of COVID-19- donor hearts. Pediatric recipients, multiorgan transplants, donors without COVID-19 testing, and recipients allocated under the old heart allocation system were excluded. One to three propensity score matching was used to match COVID+ donor heart recipients to COVID- donor heart recipients. RESULTS: Over the study period, 4,621 heart transplant recipients met inclusion-exclusion criteria, including 62 recipients of COVID+ donor hearts. After matching on pre-transplant recipient and donor characteristics, the 59 COVID+ donor heart recipients were matched to 177 COVID- donor heart recipients. Baseline characteristics were similar following matching. Thirty-day survival was similar between groups (COVID- 95.5% vs. COVID+ 100.0%, log rank p=0.10) as was six-month survival (COVID- 93.2% vs. COVID+ 98.3%, log rank p=0.15; Figure 1). National COVID+ donor heart usage varied by region, with region 11 transplanting the largest proportion of COVID+ hearts [11/62 (17.7%)] and region 10 transplanting the least [1/62 (1.64%)]. COVID+ heart utilization per region was greatest in region 1 [7/249 (2.8%)] and least in region 10 [1/384 (0.26%)]. CONCLUSION: Thirty-day and six-month survival in recipients of COVID+ donor hearts is similar to that of COVID- donor hearts. These data should encourage increased utilization of COVID+ donor hearts. Further analyses are needed to determine if long-term outcomes are equivalent between groups.