Impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients: A systematic review and meta-analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Zhenzhen , GUO Lin ,  ZHENG Hua , ZENG Dong , ZHENG Hongxiang , ZHANG Mian

Department of Critical Care Medicine, Zhengzhou Seventh People's Hospital, Zhengzhou, 450016, P. R. China;

Corresponding author：

ZHENG Hua, Email: zhenghua281@21cn.com

Keywords：

Corona Virus Disease 2019; heart transplantation; positive donor; systematic review/meta-analysis

DOI：

10.7507/1007-4848.202306024

Video：

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Objective To explore the impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. Methods The Medline, EMbase, CENTRAL, CNKI, Wanfang Data, VIP and Chinese Biomedical Abstracts Database from inception to May 2023 were searched by computer for studies about impact of SARS-CoV-2-positive donors on the prognosis of heart transplant recipients. The data were extracted from all the relevant literatures, and the quality of the data was assessed using the Newcastle-Ottawa Scale (NOS). All statistical analyses were conducted by the STATA 11.0 software. Results A total of 10 studies (NOS score ranging from 5 to 9 points) involving 643 patients were enrolled. The pooled results demonstrated that the pooled mortality of heart transplant recipients from SARS-CoV-2-positive donors was 4% (95%CI 2% to 5%). And the incidence of composite outcome, regarding graft failure, rejection and death as poor prognosis, was 7% (95%CI 5% to 9%). Besides, compared with recipients from SARS-CoV-2-negative donors, the pooled odds ratio (OR) value of death of SARS-CoV-2-positive donors was 0.68 (95%CI 0.38 to 1.22, Z=1.28, P=0.200). The pooled OR value of rejection rate was 0.41 (95%CI 0.27 to 0.64, Z=3.97, P<0.005). For the composite outcome, the pooled OR value was 0.50 (95%CI 0.37 to 0.69, Z=4.30, P<0.005). In addition, there was no statistical difference in the length of hospital stay between heart transplant recipients from SARS-CoV-2-positive donors and negative donors (SMD=–0.03, 95%CI –0.22 to 0.15, Z=0.36, P=0.720). Conclusion The application of heart from SARS-CoV-2-positive donor for transplantation is safe and feasible. However, further prospective studies with longer follow-up are still needed to verify its impact on long-term outcomes.

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2.	Schold JD, King KL, Husain SA, et al. COVID-19 mortality among kidney transplant candidates is strongly associated with social determinants of health. Am J Transplant, 2021, 21(7): 2563-2572.
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15.	Madgula AS, Nestasie M, Link C, et al. Tackling the paradox of orthotropic heart transplantation from SARS-CoV-2 positive donors: A single center experience. J Heart Lung Transplant, 2022, 41(11): 1650-1653.
16.	Montiel Villalonga P, Martínez-Alpuente I, Fernández-Ruiz M, et al. Transplantation of organs from SARS-CoV-2-positive donors: Preliminary experience from Spain. Transpl Infect Dis, 2023, 25(1): e14008.
17.	Mullan CW, Komlo C, Clark KAA, et al. Survival after heart transplantation from SARS-CoV-2-positive donors. JACC Heart Fail, 2022, 10(11): 874-876.
18.	Schold JD, Koval CE, Wee A, et al. Utilization and outcomes of deceased donor SARS-CoV-2-positive organs for solid organ transplantation in the United States. Am J Transplant, 2022, 22(9): 2217-2227.
19.	Vaidya GN, Anaya P, Ignaszewski M, et al. Patterns and outcomes of COVID-19 donor utilization for heart transplant. Clin Transplant, 2023, 37(4): e14917.
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22.	石炳毅. 继往开来, 中国器官移植的发展现状—在2018年中华医学会器官移植学年会上的报告. 器官移植, 2019, 10(1): 32-35.Shi BY. Carrying on the past and opening up a way for the future, the current development status of organ transplantation in China—Report at the 2018 annual meeting of the Chinese Medical Association on Organ Transplantation. Organ Transpl, 2019, 10(1): 32-35.
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24.	Wu C, Hu X, Song J, et al. Heart injury signs are associated with higher and earlier mortality in coronavirus disease 2019 (COVID-19). medRxiv, 2020.02. 26. 20028589.

1. Hall VG, Ferreira VH, Ku T, et al. Randomized trial of a third dose of mRNA-1273 vaccine in transplant recipients. N Engl J Med, 2021, 385(13): 1244-1246.
2. Schold JD, King KL, Husain SA, et al. COVID-19 mortality among kidney transplant candidates is strongly associated with social determinants of health. Am J Transplant, 2021, 21(7): 2563-2572.
3. Li MT, King KL, Husain SA, et al. Deceased donor kidneys utilization and discard rates during COVID-19 pandemic in the United States. Kidney Int Rep, 2021, 6(9): 2463-2467.
4. Ritschl PV, Nevermann N, Wiering L, et al. Solid organ transplantation programs facing lack of empiric evidence in the COVID-19 pandemic: A By-proxy Society Recommendation Consensus approach. Am J Transplant, 2020, 20(7): 1826-1836.
5. Kute VB, Fleetwood VA, Meshram HS, et al. Use of organs from SARS-CoV-2 infected donors: Is it safe? A contemporary review. Curr Transplant Rep, 2021, 8(4): 281-292.
6. Kanter MJ, Mahrokhian SH, Nordan T, et al. Risk factors associated with COVID-19 mortality in heart transplant recipients: A united network for organ sharing database analysis. ASAIO J, 2023, 69(8): e388-e390.
7. Esmailian G, Patel N, Patel JK, et al. Heart transplant recipient 1-year outcomes during the COVID-19 pandemic. Clin Transplant, 2022, 36(7): e14697.
8. DeFilippis EM, Wayda B, Lala A, et al. Utilization of COVID-19 positive donors for heart transplantation and associated short-term outcomes. J Heart Lung Transplant, 2023, 42(5): 651-659.
9. 中华医学会器官移植学分会, 中国医师协会器官移植医师分会, 国家人体捐献器官获取质量控制中心. 新型冠状病毒感染者器官捐献专家共识. 器官移植, 2023, 14(1): 1-10.Branch of Organ Transplantation of Chinese Medical Association, Branch of Organ Transplant Physician of Chinese Medical Doctor Association, National Quality Control Center for Human Donated Organ Procurement. Expert consensus on organ donation from patients infected with novel coronavirus in China. Organ Transpl, 2023, 14(1): 1-10.
10. Schlendorf KH, Woolley AE. Transplanting COVID-19-positive donor hearts: A previous threat, now an opportunity. JACC Heart Fail, 2023, 11(4): 476-477.
11. Margulis AV, Pladevall M, Riera-Guardia N, et al. Quality assessment of observational studies in a drug-safety systematic review, comparison of two tools: The Newcastle-Ottawa Scale and the RTI item bank. Clin Epidemiol, 2014 Oct 10: 6: 359-368.
12. Dhand A, Gass A, John D, et al. Long-term and short-term outcomes of solid organ transplantation from donors with a positive SARS-CoV-2 test. Transplantation, 2022, 106(8): e384-e385.
13. Dhand A, Okumura K, Nabors C, et al. Solid organ transplantation from COVID positive donors in the United States: Analysis of United Network for Organ Sharing Database. Transpl Infect Dis, 2023, 25(1): e13925.
14. Goldman JD, Pouch SM, Woolley AE, et al. Transplant of organs from donors with positive SARS-CoV-2 nucleic acid testing: A report from the organ procurement and transplantation network ad hoc disease transmission advisory committee. Transpl Infect Dis, 2023, 25(1): e14013.
15. Madgula AS, Nestasie M, Link C, et al. Tackling the paradox of orthotropic heart transplantation from SARS-CoV-2 positive donors: A single center experience. J Heart Lung Transplant, 2022, 41(11): 1650-1653.
16. Montiel Villalonga P, Martínez-Alpuente I, Fernández-Ruiz M, et al. Transplantation of organs from SARS-CoV-2-positive donors: Preliminary experience from Spain. Transpl Infect Dis, 2023, 25(1): e14008.
17. Mullan CW, Komlo C, Clark KAA, et al. Survival after heart transplantation from SARS-CoV-2-positive donors. JACC Heart Fail, 2022, 10(11): 874-876.
18. Schold JD, Koval CE, Wee A, et al. Utilization and outcomes of deceased donor SARS-CoV-2-positive organs for solid organ transplantation in the United States. Am J Transplant, 2022, 22(9): 2217-2227.
19. Vaidya GN, Anaya P, Ignaszewski M, et al. Patterns and outcomes of COVID-19 donor utilization for heart transplant. Clin Transplant, 2023, 37(4): e14917.
20. Eichenberger EM, Coniglio AC, Milano C, et al. Transplanting thoracic COVID-19 positive donors: An institutional protocol and report of the first 14 cases. J Heart Lung Transplant, 2022, 41(10): 1376-1381.
21. Defilippis EM, Allen LA, Bhatt AS, et al. Vaccines, antibodies and donors: Varying attitudes and policies surrounding COVID-19 and heart transplantation. J Card Fail, 2022, 28(12): 1727-1732.
22. 石炳毅. 继往开来, 中国器官移植的发展现状—在2018年中华医学会器官移植学年会上的报告. 器官移植, 2019, 10(1): 32-35.Shi BY. Carrying on the past and opening up a way for the future, the current development status of organ transplantation in China—Report at the 2018 annual meeting of the Chinese Medical Association on Organ Transplantation. Organ Transpl, 2019, 10(1): 32-35.
23. Liu PP, Blet A, Smyth D, et al. The science underlying COVID-19: Implications for the cardiovascular system. Circulation, 2020, 142(1): 68-78.
24. Wu C, Hu X, Song J, et al. Heart injury signs are associated with higher and earlier mortality in coronavirus disease 2019 (COVID-19). medRxiv, 2020.02. 26. 20028589.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

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