Clinical outcomes after COVID-19-positive donor heart transplantation in the United States pediatric population.

Abstract

To evaluate pediatric heart transplant outcomes for COVID-19-positive versus COVID-19-negative donors in United States. We queried the Standard Transplant Analysis and Research database for pediatric (<18 years) primary heart transplant recipients (2020-2024). Donors were classified as COVID-19 positive if testing positive within 7 days of transplantation. COVID-19-positive and COVID-19-negative recipients were 1:5 propensity matched by demographics/baseline factors. Testing of COVID-19 status and donor/recipient height mismatch interaction was performed. Outcomes included mortality and graft survival. Of 1978 transplants, 60 (3.0%) used COVID-19-positive donor hearts. Recipients of COVID-19 positive hearts were on average younger (5.7 vs 7.6 years, P = .019), received organs from greater average distances (360 vs 303 miles, P = .044), and had greater peritransplant extracorporal membrane oxygenation use (P < .047), with other characteristics similar. Mortality did not differ at 6 months, 1 year, or 1.5 years, but cumulative mortality at 2 and 3 years was greater in recipients of COVID-19 positive both unmatched (hazard ratio, 2.12; P = .029) and matched (hazard ratio, 2.19; P = .044). At 3 years, survival was 71.5% for recipients of COVID-19-positive versus 86.3% for recipients of COVID-19-negative hearts. Graft failure was rare and cumulative risk was insignificant. Mortality risk of COVID-19 positive donor heart recipients was magnified with height mismatch (P = .048). Pediatric heart transplant recipients of donors who are COVID-19-positive had significantly increased cumulative mortality. Until more data have accrue, transplant teams should exercise caution in accepting hearts of donors who are positive for COVID-19 for pediatric patients.