Initial analysis reveals mixed results

In a recent study published in Journal of the American College of Cardiologyinvestigators investigated the use of donors infected with coronavirus disease 2019 (COVID-19), donor and recipient characteristics, and early outcomes after heart transplantation (HT) in the United States (US).

study: Early Results of Adult Heart Transplantation from COVID-19 Infected Donors. Image credit: Explode / Shutterstock

Background

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) epidemic poses multiple challenges for heart transplant centers, impacting all aspects of HT, including waiting list mortality, recipient survival, and donor heart procurement. It has a bad effect on the sides. Recent case series and single-center studies have reported acceptable results in the short term, weeks or months, of heart transplantation with donors infected with SARS-CoV-2.

However, because SARS-CoV-2 infection can cause subclinical endothelial dysregulation and myocardial damage among potential donors, large-scale trials evaluating long-term outcomes are needed. Studies involving non-heart transplant recipients have reported an increased risk of poor cardiovascular outcome in the first month after acute SARS-CoV-2 infection among hospitalized and non-hospitalized patients.

About research

In this retrospective, registry-based study, investigators evaluated early outcomes of adult HT from donor individuals infected with SARS-CoV-2.

Patient-level anonymized data from 27,862 individual donors were obtained from May 2020 to June 2022 from the Organ Procurement and Transplantation Network (OPTN), a national Organ Sharing Network (UNOS) database. rice field. Only individuals with available data on SARS novel coronavirus-2 nucleic acid The database included amplified testing (NAT) and organ donation.

A total of 60,699 COVID-19 NATs were performed by: Nasopharyngeal swab Pre-organ donation specimen, bronchoalveolar lavage (BAL), or tracheal aspirate sample. A person who reported a positive NAT at any time during his or her end-of-life hospitalization was considered a ‘COVID-19 donor’.

Donors infected with SARS-CoV-2 were classified as “active novel coronavirus disease (aCOV)” (aCOV) and “recently recovered novel coronavirus (rrCOV)” donors. The aCOV group included individuals in whom he reported NAT positive during his first 2 days after organ donation. The rrCOV group included people in whom he reported NAT-positive early on, but who had a NAT-negative result before organ donation.

Individuals who were NAT-positive more than 2 days prior to organ donation were included in the aCOV group unless there was evidence of subsequent adverse reports within 2 days of the most recent NAT-positive report. The team excluded donor individuals with antibodies to COVID-19. antigen Non-NAT test report. They compared heart transplant outcomes and performed Cox proportional hazards regression modeling to calculate hazard ratios (HR).

Participants were followed until September 30, 2022. Pediatric transplant recipients, adults with multiple organ transplants or retransplants, and patients with missing HT follow-up data were excluded from the analysis. The primary study outcome was death from any cause at 6 and 12 months after initiation of follow-up. Results from secondary studies included stroke, pacemaker use, hemodialysis, and length of stay after heart transplant.

result

Of the 1,445 identified SARS-CoV-2-infected donors, 428 had rrCoV and 1,017 had aCOV, and of 309 heart transplants with SARS-CoV-2-infected donors, 239 had adult HT ( aCOV and rrCOV were 150 and 89, respectively). ) met the eligibility criteria. SARS-CoV-2 infected donors were younger and predominantly male compared to non-COV donors.

Compared with transplant recipients with non-COV donor individuals, transplant recipients with aCOV donor individuals had higher mortality at 6 and 12 months, with HR values ​​of 1.7 and 2.0, respectively . Transplant recipients using non-COV and rrCOV donor individuals had comparable mortality at his 6 months and her 12 months. Equivalent secondary results were obtained for HT from SARS-CoV-2 infected and uninfected donors.

Moreover, rrCoV and aCOV donor individuals showed comparable secondary outcomes. Similar results were observed in propensity score (PS) matched study cohorts. The number of HT in donors infected with SARS-CoV-2 increased during the study period. Interestingly, a spike in SARS-CoV-2 infections in the US community was followed by a peak in HT by donor individuals infected with SARS-CoV-2.

Conclusion

Overall, the study results showed higher mortality at 6 and 12 months in patients receiving hearts from aCOV donors, whereas patients receiving hearts from rrCOV donors and hearts from non-COV donors Transplanted patients showed similar mortality rates. The results of this study showed that heart transplantation from rrCOV donors is safe, while heart transplantation from aCOV donors may be associated with increased mortality.

A significant upward trend in the use of SARS-CoV-2 infected (rrCoV and aCOV) donors was observed during the study period. HT facilities selectively selected SARS-CoV-2-infected donors who were predominantly young and male. The donor probably underwent multiple rounds of SARS-CoV-2 NAT before organ donation, and the number of NAT-positive individuals was higher than that of NAT-negative individuals for SARS-CoV-2 (3 and 2 NATs per donor, respectively). inspection).

Increased mortality at 6 and 12 months in adult transplant recipients from aCOV donors was concerning. Heart transplant centers should thoroughly evaluate the risk/benefit ratio of transplanting hearts from aCOV donor individuals. Further studies included cycle threshold (Ct) values ​​(to assess viral load), donor infection history (including date of diagnosis, symptoms, causative SARS-CoV-2 strain), COVID-19 vaccination Data analysis should be incorporated, such as circumstances, specific treatments, etc. administered to her HT recipient from a COVID-19 donor.