Patterns and outcomes of COVID-19 donor utilization for heart transplant

Background: The outcomes following COVID-19 positive donor (CPD) utilization for heart transplant are unknown. Methods: UNOS database was analyzed for heart transplants performed from the declaration of COVID-19 pandemic until September 30, 2022. Result: Since the onset of pandemic, there were 9876 heart transplants reported. COVID-19 antigen or NAT results were available in 7698 adult donors within 14 days of donation, of which 177 (2.3%) were positive. There was no difference in recipient demographics, including age (COVID positive donor vs. negative: 55 vs. 56 years, p =.2) and BMI. Listing status 1 and 2 were similar in both groups (7% vs. 10% and 48% vs. 49% respectively, p =.4). Durable and temporary mechanical support were similar in both groups pre-transplant (both groups 33%, p =.9). There was no difference in days on the waitlist (median 31 days, p =.9). Simultaneous renal transplant rates were similar (11% vs. 10%, p =.9). CPD utilization has increased since the onset of the pandemic, and the adoption is present across most UNOS regions. Post-transplant, there was no difference in length of stay (median 16 vs. 17 days, p =.9) and acute rejection episodes prior to discharge (3% vs. 8%, p =.1). In survival analysis of 90-day follow up, number of deaths reported were comparable (5% in both groups, p =.9) Follow-up LVEF was comparable (62% vs. 60%, p =.4). Conclusion: Active COVID-19 infection in donors did not affect survival or rejection rates in the short-term post-heart transplant.