Safety and 1‐Year Outcomes After Transplanting Hearts From SARS‐CoV‐2 Positive Donors: Insights From an International Analysis

ABSTRACT Background Uncertainties persist regarding the utilization of hearts from SARS‐CoV‐2‐positive donors for heart transplant (HT). This international study analyzed such HTs within the United States (US) and Germany, focusing on 1‐year outcomes and granular safety data. Methods Data was obtained from the United Network for Organ Sharing (UNOS) registry (03/2021–08/2022) and collaborating with the German Organ Procurement Organisation (DSO; 03/2022–02/2023). HTs from currently and recently (up to 21 days in UNOS and 90 days in DSO) SARS‐CoV‐2‐positive donors were included. Results In the US, 274 HTs from SARS‐CoV‐2 donors were analyzed (50.7% SARS‐CoV‐2‐positive until organ recovery). Compared to 3952 HTs from SARS‐CoV‐2‐negative donors, acute rejection was less frequent (10.6% vs. 17.1%, p = 0.006). One‐year graft and recipient survival ( p = 0.327) and rehospitalization rates ( p = 0.592) did not differ. In Germany, 30 HTs utilized SARS‐CoV‐2‐positive hearts. Follow‐up was obtained for 23 (76.7%). 43.5% of the donors were positive until recovery. Two recipients (8.7%) tested positive for SARS‐CoV‐2 21 and 65 days post‐transplant, both unlikely donor‐derived. 8.7% had severe PGD, 8.7% acute cellular rejection ≥ 2R. One‐year survival was 91.3%. None experienced myocarditis or thromboembolism. Conclusion Using selected SARS‐CoV‐2‐positive hearts for transplant appears safe with no differences in 1‐year survival, no evidence of viral transmission or SARS‐CoV‐2‐related adverse cardiovascular events.