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

Document Type

Article

Publication Date

7-2026

Identifier

DOI: 10.1016/j.jtcvs.2025.12.022

Abstract

OBJECTIVE: To evaluate pediatric heart transplant outcomes for COVID-19-positive versus COVID-19-negative donors in United States.

METHODS: 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.

RESULTS: 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).

CONCLUSIONS: 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.

Journal Title

The Journal of thoracic and cardiovascular surgery

Volume

172

Issue

1

First Page

191

Last Page

199

MeSH Keywords

Humans; Heart Transplantation; Child; COVID-19; Female; Child, Preschool; United States; Male; Graft Survival; Adolescent; Tissue Donors; Infant; Donor Selection; Risk Factors; Treatment Outcome; Retrospective Studies; SARS-CoV-2; Risk Assessment

PubMed ID

41456819

Keywords

COVID-19; clinical outcomes; donor selection; graft failure; pediatric heart transplant

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