One Year Outcomes Following Transplantation with COVID-19-Positive Donor Hearts: A National Database Cohort Study

The current understanding of the safety of heart transplantation from COVID-19+ donors is uncertain. Preliminary studies suggest that heart transplants from these donors may be feasible. We analyzed 1-year outcomes in COVID-19+ donor heart recipients using 1:3 propensity matching. The OPTN database was queried for adult heart transplant recipients between 1 January 2020 and 30 September 2022. COVID-19+ donors were defined as those who tested positive on NATs or antigen tests within 21 days prior to procurement. Multiorgan transplants, retransplants, donors without COVID-19 testing, and recipients allocated under the old heart allocation system were excluded. A total of 7211 heart transplant recipients met the inclusion criteria, including 316 COVID-19+ donor heart recipients. Further, 290 COVID-19+ donor heart recipients were matched to 870 COVID-19− donor heart recipients. Survival was similar between the groups at 30 days (p = 0.46), 6 months (p = 0.17), and 1 year (p = 0.07). Recipients from COVID-19+ donors in the matched cohort were less likely to experience postoperative acute rejection prior to discharge (p = 0.01). National COVID-19+ donor heart usage varied by region: region 11 transplanted the most COVID-19+ hearts (15.8%), and region 6 transplanted the fewest (3.2%). Our findings indicate that COVID-19+ heart transplantation can be performed with safe early outcomes. Further analyses are needed to determine if long-term outcomes are equivalent between groups

Transcontinental heart transplant using SherpaPak cold static storage system

Organ preservation in heart transplantation is key to preventing primary graft dysfunction, the most common cause of early graft loss. Historically, the standard of care was preservation on ice, with no monitoring ability and problems with even temperature distribution. Recently, the SherpaPak, an Food & Drug Administration-approved transport device, has emerged as a solution to these 2 issues, allowing for even temperature distribution, no organ contact with ice, and continuous monitoring during transport. This method of transport falls under static cold preservation, but may allow for longer ischemic times beyond the recommended 4-hour limit. Here, we report a case of heart transplantation using the SherpaPak transport device for a distance of almost 3000 miles and total ischemic time over 7 hours—the longest yet reported for a donor heart transported using the SherpaPak system. The patient had excellent functional outcomes with no evidence of primary graft dysfunction. This case suggests that, with careful donor and recipient selection, SherpaPak may potentially be used for longer distances and ischemic times than initially recommended, as a safe and cheaper alternative to ex-vivo perfusion devices

The Public Health Service “Increased Risk” 2020 Policy Change Has not Improved Organ Utilization in the United States: A Nationwide Cohort Study

Objective:. To assess the effects of the 2020 United States Public Health Service (PHS) “Increased Risk” Guidelines update. Background:. Donors labeled as “Increased Risk” for transmission of infectious diseases have been found to have decreased organ utilization rates despite no significant impact on recipient survival. Recently, the PHS provided an updated guideline focused on “Increased Risk” organ donors, which included the removal of the “Increased Risk” label and the elimination of the separate informed consent form, although the actual increased risk status of donors is still ultimately transmitted to transplant physicians. We sought to analyze the effect of this update on organ utilization rates. Methods:. This was a retrospective analysis of the Organ Procurement and Transplantation Network database which compared donor organ utilization in the 2 years before the June 2020 PHS Guideline update for increased-risk donor organs (June 2018–May 2020) versus the 2 years after the update (August 2020–July 2022). The organ utilization rate for each donor was determined by dividing the number of organs transplanted by the total number of organs available for procurement. Student t test and multivariable logistic regression models were used for analysis. Results:. There were 17,272 donors in the preupdate cohort and 17,922 donors in the postupdate cohort; of these, 4,977 (28.8%) and 3,893 (21.7%) donors were considered “Increased Risk”, respectively. There was a 2% decrease in overall organ utilization rates after the update, driven by a 3% decrease in liver utilization rates and a 2% decrease in lung utilization rates. After multivariable adjustment, donors in the postupdate cohort had 10% decreased odds of having all organs transplanted. Conclusions:. The 2020 PHS “Increased Risk” Donor Guideline update was not associated with an increase in organ utilization rates in the first 2 years after its implementation, despite a decrease in the proportion of donors considered to be at higher risk. Further efforts to educate the community on the safe usage of high-risk organs are needed and may increase organ utilization