Clinical Outcomes after COVID-19-Positive Donor Heart Transplantation in the United States Pediatric Population
Presenter Status
Fellow
Abstract Type
Clinical Research
Primary Mentor or Principal Investigator
Edo K Bedzra
Presentation Type
Poster
Start Date
21-5-2026 12:00 PM
End Date
21-5-2026 1:00 PM
Abstract Text
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 seven days of transplantation. COVID-19 positive and COVID-19 negative recipients were 1:5 propensity matched by demographics/baseline factors. Testing of COVID19 status, and donor/recipient height mismatch interaction was performed. Outcomes included mortality and graft survival.
Results: Of 1,978 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=0.019), received organs from greater average distances (360 vs. 303 miles, p=0.044), and had higher peri-transplant ECMO usage (p< 0.047), with other characteristics similar. Mortality did not differ at six months, one year, or 1.5 years, but cumulative mortality at two and three years was higher in COVID-19 positive recipients both unmatched (Hazard Ratio=2.12, p=0.029) and matched (Hazard Ratio=2.19, p=0.044). At three years, survival was 71.5% for COVID-19 positive recipients versus 86.3% for COVID-19 negative recipients. Graft failure was rare and cumulative risk was insignificant. Mortality risk of COVID-19 positive donor heart recipients was magnified with height mismatch (p=0.048).
Conclusions: Pediatric heart transplant recipients of COVID-19 positive donors had significantly increased cumulative mortality. Until more data accrues, transplant teams should exercise caution in accepting COVID-19 positive donor hearts in pediatric patients.
Clinical Outcomes after COVID-19-Positive Donor Heart Transplantation in the United States Pediatric Population
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 seven days of transplantation. COVID-19 positive and COVID-19 negative recipients were 1:5 propensity matched by demographics/baseline factors. Testing of COVID19 status, and donor/recipient height mismatch interaction was performed. Outcomes included mortality and graft survival.
Results: Of 1,978 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=0.019), received organs from greater average distances (360 vs. 303 miles, p=0.044), and had higher peri-transplant ECMO usage (p< 0.047), with other characteristics similar. Mortality did not differ at six months, one year, or 1.5 years, but cumulative mortality at two and three years was higher in COVID-19 positive recipients both unmatched (Hazard Ratio=2.12, p=0.029) and matched (Hazard Ratio=2.19, p=0.044). At three years, survival was 71.5% for COVID-19 positive recipients versus 86.3% for COVID-19 negative recipients. Graft failure was rare and cumulative risk was insignificant. Mortality risk of COVID-19 positive donor heart recipients was magnified with height mismatch (p=0.048).
Conclusions: Pediatric heart transplant recipients of COVID-19 positive donors had significantly increased cumulative mortality. Until more data accrues, transplant teams should exercise caution in accepting COVID-19 positive donor hearts in pediatric patients.
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Poster Board Number: 24