Sivank Madan, MD, MHA
Credit: Montefiore Medical Center
A study by researchers at the Albert Einstein College of Medicine raises red flags related to the potential impact of using COVID-19-positive donor hearts on post-transplant survival.
The study, which surveyed more than 27,000 donors from the United Organ Sharing Network (UNOS), found that those who received heart transplants from active, COVID-19-positive donors had a near risk of death after six months. doubled, and more than doubled the risk of death. Results were obtained at one year compared with patients whose hearts were donated from non-coronavirus donors. However, the researchers found that the 6-month and 1-year mortality rates of patients receiving transplants from recently recovered COVID-19 donors were similar to those receiving transplants from non-COVID-19 heart donors. pointed out there is.
“These early trends are strong enough that heart transplant centers should continue to thoroughly assess and consider the risks and benefits of using hearts from donors during COVID-19 activity. It’s alarming,” said principal investigator Shivank Madan, M.D., Ph.D., a cardiologist at the center. Advanced Cardiac Care Center at Montefiore Medical Center/Albert Einstein College of Medicine in New York.2
By 2023, the COVID-19 pandemic will impact lives around the world. In total, more than 6 million people have been hospitalized and more than 1.1 million people have died in the United States due to COVID-19 since the pandemic began, according to the US Centers for Disease Control and Prevention (CDC). Headlines related to the novel coronavirus disease (COVID-19) are myriad in size and coverage, but a consistent theme in much of the coverage is the long-term health impact, including cardiovascular health. was.
In the current study, Madan et al., Albert Einstein College of Medicine Montefiore Medical Center, compared the characteristics and outcomes of heart transplantation using hearts from donors with COVID-19 to those from non-COVID-19 donors. I tried to compare it with heart transplantation. To do so, the researchers designed the research effort as an analytic analysis of data obtained from UNOS. The UNOS database, a private non-profit organization that collects data from transplant hospitals and organ procurement organizations, identified 60,699 novel coronavirus nucleic acid tests (NATs) during the study period defined as May 2020 to June 2022. provided researchers with information on 27,862 donors who underwent .
For the purposes of analysis, donors were considered COVID-19 donors if they were NAT-positive at any time during their end-of-life hospitalization, and activity if they were NAT-positive within 2 days of organ harvest. It was subclassified as a sexually transmitted COVID-19 and, in the case of NAT, as a recently recovered novel coronavirus. Initially positive, but before procurement he was NAT negative. Investigators found that donors who tested positive for NAT more than two days prior to procurement were tested for active COVID-19, unless there was evidence of a negative NAT more than 48 hours after the last positive NAT test. -19).
During the study period, researchers identified 1445 COVID-19 donors. Of these, 1,017 were considered active COVID-19 and 428 were considered recently resolved COVID-19. A total of 309 heart transplants using COVID-19 donors and 239 adult heart transplants from COVID-19 donors met the study criteria. Of the 239 transplants from COVID-19 donors, 150 met the criteria for active COVID-19 and 89 met the criteria for recently recovered COVID-19.
The researchers noted a similar age of COVID-19 donors (55 years) compared to non-COVID-19 donors. [42-63] versus 57 [46-64] years), female (23.85% vs 27.03%), black race (23.43% vs 24.22%), size disparity (12.13% vs 11.59%), ischemic etiology (29.29% vs 28.01%), UNOS emergency, aorta Internal balloon pump (27.20% vs 26.98%), LVAD (29.71% vs 30.99%) or ECMO support (5.02% vs 5.78%) (all P. >.05).
A survey of outcomes showed that heart transplantation from a donor with active COVID-19 was associated with an increased risk at 6 months (hazard ratio) [HR]1.74 [95% Confidence interval [CI]1.02-2.96]; P.=.043) and 1 year (HR, 1.98) [95% CI, 1.22-3.22]; P.=.006), compared with patients receiving transplants from non-COVID-19 donors. Further analysis showed similar observed weekly mortality at 6 months and 1 year when mortality was compared between recently recovered and non-COVID-19 donors. The researchers also emphasized that similar results were observed in trend-matched cohorts.
Researchers cautioned against increased utilization of COVID-19 donors during the pandemic, but transplant centers are selective, with the majority of donor hearts used coming from young donors He pointed out that about 80% were men. The researchers asked to consider study limitations before overinterpreting the results. Specific limitations highlighted by the researchers include variability in the timing and frequency of COVID-19 testing during terminal hospitalization, as well as the date of onset, symptom burden, and vaccination status of donors and recipients. Lack of information on COVID-19 activity was included. .
References:
- Hsu JJ, Al-Saffar F, Ardehali R, et al. Heart transplantation during the early stages of the COVID-19 pandemic: a single-center case series. clin transplant. 2020;34(9):e14042. Doi: 10.1111/ctr.14042
- The use of covid-19-positive donor hearts may impact post-transplant survival. American College of Cardiology. May 17, 2023. Accessed May 17, 2023. https://www.acc.org/About-ACC/Press-Releases/2023/05/17/18/13/Using-COVID-19-Positive-Donor-Hearts-May-Impact-Post-Transplant-Survival.
- Centers for Disease Control and Prevention. Novel coronavirus data tracker. Atlanta, GA: US Department of Health and Human Services, CDC. May 17, 2023. https://covid.cdc.gov/covid-data-tracker