Abstract
PURPOSE: HT centers may avoid donors with Covid19 (Cov19) infection due to uncertain risk of virus transmission and possibility of virus mediated myocardial injury. We investigated Cov19 donor utilization, transplant characteristics and early post HT outcomes in the U.S. METHODS: Between May 2020-June 2022, n=27,862 donors in UNOS had data available on Cov19 NAT tests and organ disposition. Since donors may get Cov19 testing multiple times prior to organ retrieval, additional data on multiple Cov19 NAT was requested and analyzed. Donors were classified Cov19-donors if NAT+ at any time during terminal hospitalization, and subclassified as Active Cov19(A-Cov19) if NAT+ at organ procurement and ‘Recently Active Cov19’(rA-Cov19) if NAT+ initially but NAT negative prior to organ retrieval. HT outcomes using Cov19 and nonCov19 donors were compared by Kaplan Meier (KM) and Cox hazards ratio (HR). RESULTS: Prior to organ retrieval, 27,862 donors had 60,699 Cov19 NAT tests done. Of these, n=1445 were Cov19 donors, n=125 indeterminate and n=26,292 nonCov19. Of Cov19 donors, n=1017 were A-Cov19 and n=428 rA-Cov19. 309 HTs used hearts from Cov19 donors and 239 (n=150 A-Cov19, n=89 rA-Cov19) met study criteria. Compared to nonCov19, Cov19 donors used for adult HT were younger [30(23-37) vs 32(25-40)yrs] and mostly male (80.3% vs 72.1%), p<0.05. Otherwise, HTs from Cov19 and nonCov19 donors were similar in recipient age, race, etiology, UNOS status, BMI, LVAD, ECMO use; and donor LVEF, and DCD status. HTs from Cov19 and nonCov19 donors had similar survival up to 3 months [CoxHR=1.23(0.63-2.39), p=0.54, adjusted for baseline characteristics, Fig1A]. Survival was also statistically similar in A-Cov19 and rA-Cov19 donor HT cohorts [CoxHR=1.47(0.40-5.48), p=0.56, Fig1B]. HTs from Cov19 donors increased from n=5 in May-Dec 2020 to n=207 in Jan-June 2022, p<0.05 for trend. Data on Cov19 treatment was not available. CONCLUSION: In the largest analysis to date, HTs from selective Cov19 donors had acceptable early outcomes. Longer follow up is needed.