Challenges in Heart Transplantation During COVID-19 Pandemic in Brazil

PURPOSE: A recent UNOS analysis comparing COVID-19 to pre-COVID-19 era found an increased waitlist inactivation, decreased waitlist addition, and decreased in numbers of heart transplant (HT). In Brazil, a pronounced negative effect on transplant was anticipated but has not been measured so far. Our objective was to evaluate the impact of COVID-19 pandemic on heart donation and HT. METHODS: We performed a descriptive analysis of data related to patients registered in HT waitlist and numbers of HT performed from March 2018 to August 2019 (pre-COVID era) and March 2020 to August 2021 (COVID era), by reviewing medical records and data from State Transplant System. RESULTS: A total of 221 patients were included in HT waitlist from 2018 to 2021. Approximately the same number of patients were listed in pre-COVID and COVID era (111 vs 110, respectively). Mean age of patients were 48.7 in the pre COVID and 48.9 years in the COVID era (p=0.91). The majority were listed as top priority criteria, 94 (85.5%) in COVID vs 100 (90.1%) in pre-COVID era, p=0.293, mostly due to mechanical circulatory assist devices ECMO and Centrimag (10.9% vs 18%), and intra-aortic balloon pump (41.8 % vs 39.6%) respectively, p=0.496. There was no difference in the survival of patients in waitlist (p = 0.226). Regarding number of HT, we observed highest absolute number of surgeries in the pre-COVID era (78 vs 66), with no statistical significance (p=0.109). There was no difference between the deaths after HT, 17 (15.3%) in pre-COVID and 9 (8.2%) in COVID era, p=0.249. During the peak of number of COVID-19 cases in Brazil (may-july 2020 and february-april 2021) we observe a reduction in overall heart transplant procedures an inclusion in waitlist (figure). CONCLUSION: To the best of our knowledge, this is the first report of the impact of COVID - 19 on solid organ donation and HT. There were no differences between number of patients included in HT waitlist and outcomes after HT before and during COVID. However, there was a decrease in number of HT and inclusion in HT waitlist during the peak of COVID-19.