Safety and 1-Year Outcomes After Transplanting Hearts From SARS-CoV-2 Positive Donors: Insights From an International Analysis

Background

Uncertainties persist regarding the utilization of hearts from SARS-CoV-2-positive donors for heart transplant (HT). This international study analyzed such HTs within the United States (US) and Germany, focusing on 1-year outcomes and granular safety data.

Methods

Data was obtained from the United Network for Organ Sharing (UNOS) registry (03/2021–08/2022) and collaborating with the German Organ Procurement Organisation (DSO; 03/2022–02/2023). HTs from currently and recently (up to 21 days in UNOS and 90 days in DSO) SARS-CoV-2-positive donors were included.

Results

In the US, 274 HTs from SARS-CoV-2 donors were analyzed (50.7% SARS-CoV-2-positive until organ recovery). Compared to 3952 HTs from SARS-CoV-2-negative donors, acute rejection was less frequent (10.6% vs. 17.1%, p = 0.006). One-year graft and recipient survival (p = 0.327) and rehospitalization rates (p = 0.592) did not differ. In Germany, 30 HTs utilized SARS-CoV-2-positive hearts. Follow-up was obtained for 23 (76.7%). 43.5% of the donors were positive until recovery. Two recipients (8.7%) tested positive for SARS-CoV-2 21 and 65 days post-transplant, both unlikely donor-derived. 8.7% had severe PGD, 8.7% acute cellular rejection ≥ 2R. One-year survival was 91.3%. None experienced myocarditis or thromboembolism.

Conclusion

Using selected SARS-CoV-2-positive hearts for transplant appears safe with no differences in 1-year survival, no evidence of viral transmission or SARS-CoV-2-related adverse cardiovascular events.