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COVID-19-positive donor hearts are associated with poor recipient survival

COVID-19-positive donor hearts are associated with poor recipient survival


Editor’s Note: For the latest news and guidance on COVID-19, see Medscape’s article. Coronavirus Resource Center.

A new study warns against using donor hearts infected with active COVID-19 in heart transplant surgery.

Heart transplant recipients from donors with active COVID-19 should receive heart transplant recipes from recently recovered COVID-19 donors or non-coronavirus donors. The researchers found an increased risk of dying at 6 months and 1 year compared to ents.

“These early trends are sufficiently concerning that heart transplant The center should continue to thoroughly evaluate and consider the risks and benefits of using hearts from active COVID-19 donors,” said Montefiore Medical Center/Albert Einstein College of Medicine Advanced Cardiac Therapies. said Shivank Madan, M.D., Ph.D., cardiologist and principal investigator at the center. The City of York said in a statement:

The research publish online May 17th Journal of the American College of Cardiology.

Evolving Problems, No Clear Agreement

Novel coronavirus infection (COVID-19) can cause latent endothelial dysfunction and myocardial damage in potential donors. At this time, there is no clear consensus regarding the evaluation and use of COVID-19 donors in heart transplantation.

Previous data from two small studies showed that patients receiving hearts from COVID-19-positive donors may have similar short-term outcomes to those receiving hearts from COVID-negative donors. suggested that it was high. Reported by | Medscape Cardiology.

For this analysis, Madan et al. identified 27,862 donors in the Organ Sharing Network’s database between May 2020 and June 2022 and performed 60,699 COVID-19 nucleic acid amplifications before organ procurement. I did an inspection.

Donors are considered COVID-19 donors if they test positive while in a terminal hospital. Those who tested positive within 2 days of organ procurement were given active COVID-19 status and initially tested positive but became negative before organ procurement A person was given a recently recovered COVID-19 condition.

Of the 1,445 COVID-19 donors, 1,017 were classified as ongoing cases and 428 as recently resolved cases. Overall, 309 heart transplants used COVID-19 donors, of which 239 adult heart transplants were included in the analysis (150 ongoing infections, 89 recently recovered infections). .

Heart transplantation from active COVID-19 donors was associated with increased risk of death at 6 months (hazard ratio) [HR]1.74; 95% confidence interval [CI]from 1.02 to 2.96. P. = .043) and 1 year (HR, 1.98; 95% CI, 1.22–3.22; P. =.006), compared to heart transplants from non-COVID-19 donors.

Six-month and 1-year mortality rates were 13.8% and 23.2%, respectively, in recipients of active COVID-19 donor hearts compared with recipients of non-COVID-19 donor hearts were 7% and 9.2%, respectively.

Heart transplants from recently recovered and non-coronavirus donors had similar mortality rates at 6 months and 1 year. Results were similar in trend-matched cohorts.

Caveats and Precautions

“This study highlights the importance of continuous evaluation and perhaps the need for a more nuanced approach to exploiting this new donor pool,” write Madan et al.

“Further studies with more patients, longer-term follow-up, and more detailed clinical data are needed to assess the outcome of treatment. [heart transplantation] They are from donors infected with COVID-19,” they added.

Sean Pinney, M.D., chief of cardiology at Mount Sinai Morningside in New York City, requested comment, stating, “This carefully considered analysis was performed in the presence of hearts from donors with active or recent COVID-19. It is a cautionary tale about accepting the

“In contrast to two previous reports that found no increased risk of adverse outcomes, this study noted an increased risk of death associated with cardiac use in COVID-19 patients. said Pinney. | Medscape Cardiology.

“Although there appears to be an indication of harm, I do not think it is wise to draw too many conclusions from the data presented. This analysis does not suggest possible mechanisms to explain the observed increased mortality.” I can’t provide details of the,” Pinney said. .

“It’s strange that signs of harm don’t show up until more than three months after the transplant,” Pinney says. pointed out Mr.

The Heart Transplant Program “needs to continue to carefully weigh the pros and cons of using these donor organs, keeping in mind that transplant candidates on the list may have a very high mortality rate. Using carefully selected organs from COVID-19 patients would still be in their best interest,” Pinney said. | Medscape Cardiology.

Also providing an outside perspective, Alex Layentovic, M.D., medical director of the Heart Transplant Program at New York University Langone Transplant Institute in New York City, said the study included “details about the viral load in donors of the novel coronavirus.” No,” warned of missing data.

A donor may have a ‘very high’ cycle threshold, which means that the novel coronavirus is dying out, or a ‘very low’ cycle threshold, which indicates a high viral load. “This study doesn’t go to that level of granularity,” Layentovic said. | Medscape Cardiology.

“A donor with active COVID-19 probably wouldn’t be accepted by anyone. I think,” Layentovic said.

“I hope that in the future, this problem will become less and less and we can stop making these kinds of decisions,” he added.

J. am col cardiole. It will be published online on May 17, 2023. overview

There was no funding for this study. Madang, Pinney and Layentovic have not disclosed any financial relationships involved.

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