A person with heart failure in dire need of a new heart may have faced delays in getting one during the pandemic when potential donors tested positive for COVID-19.
As some centers began accepting these hearts for transplant anyway, data from a new study shows that hearts from COVID-19 positive donors may be as safe to transplant as those from someone without the virus.
"These findings suggest that we may be able to be more aggressive about accepting donors that are positive for COVID-19 when patients are in dire need of an organ for heart transplantation," said study author Samuel Kim, a third-year medical student at the David Geffen School of Medicine at University of California, Los Angeles.
The study, to be presented at the American Heart Association's annual meeting Nov. 5-7 in Chicago, reviewed the cases of transplant recipients in the first 30 days after their surgery using the United Network for Organ Sharing database.
The database included information on all adult heart transplants in the United States from February 2021 to March 2022. Among a total of 3,289 heart donations, there were 84 from COVID-positive donors.
Researchers found that both groups of donor organ recipients had similar rates of death in the hospital and at 30 days after transplantation. They also had similar rates of complications. This included lung complications or organ rejection.
For patients with the hearts from people who were not infected with COVID-19, the average hospital stay was 17 days. It was 15 days for those receiving a heart from a COVID-positive donor.
Organ rejection occurred in 2.4% of the recipients from COVID-19-positive donors. It happened in 1% of the others.
About 97% of those who received hearts from donors without the virus survived, as did 96.1% of those who received hearts from people with the virus.
None of the four patients who died after receiving a heart from a COVID-positive donor died from respiratory causes or infections, the study found.
Researchers expressed surprise at the results.
"Specifically, we thought death from respiratory or lung-related causes would be a problem among recipients receiving donor hearts with COVID-19," Kim said in a heart association news release. "Yet, we found no such differences, and in fact, this study offers early evidence that COVID-19-positive donor hearts may be as safe as hearts without COVID-19 for heart transplantation."
The 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines for managing heart failure recommend heart transplantation for people who progress to advanced (stage D) heart failure.
By the time they reach stage D, people have shortness of breath, fatigue and swelling that interfere with daily life. This can lead to recurrent hospitalizations.
In the United States, 3,658 people received hearts in 2020, up from 1,676 in 1988, according to the American Heart Association's Heart Disease and Stroke Statistics--2022.
More than 3,400 Americans are currently waiting for a heart.
"Despite the increased need for this operation, there is a continued shortage of available donor organs for people in need of transplantation. The COVID-19 pandemic made things worse with an increased rate of donors testing positive for COVID-19, which generally renders the donors unsuitable for transplantation," Kim said. "However, several academic centers have started to use COVID-19-positive donor hearts for heart transplantation in recent months and have reported good results."
Still, the study size was small. Longer-term studies are needed to assess how patients receiving hearts from COVID-19-positive donors fare beyond 30 days after surgery, researchers said.
"These findings provide evidence that outcomes were similar at 30-days post-transplant among patients who received COVID-19-positive donor hearts, so the potential risks appear to be lower than expected," said Dr. Eldrin Lewis, an advanced heart failure and heart transplant specialist, the Simon H. Stertzer M.D. Professor of Cardiovascular Medicine and chair of the division of cardiovascular medicine at Stanford University in California.
"In turn, this may help to address the shortages in donor hearts for transplantation and reduce waiting times, since people often get sicker as heart failure progresses while waiting for a donor heart to become available," Lewis said in the release.
Findings presented at medical meetings are considered preliminary until published in a peer-reviewed journal.
The U.S. National Heart, Lung and Blood Institute has more on heart failure.
SOURCE: American Heart Association, news release, Oct. 31, 2022