RESULTS:
The first confirmed case of COVID-19 in the state of Tennessee was on March 5, 2020. By June 30, 2020, the total number of confirmed cases in the state was 43,806. Over this same period of time, our total cardiac volume was 488 cases compare to 521 cases during March-June 2019. The most significant decrease in volume was seen in April 2020 where volume was reduced by nearly 30% compared to the previous year.
From March-June 2020, 43 total orthotopic heart transplants were performed. This includes three re-transplants and seven multi-organ transplants (6 heart/kidney; 1 heart/liver; 0 heart/lung). The average recipient age was 54.2 +/- 13.9 years and 29 recipients were male and 14 were female. Thirty recipients were Caucasian. Thirteen recipients were African American. There were 11 blood type A recipients, seven blood type B recipients, one blood type AB recipient and 24 blood type O recipients. Sixteen patients had pre-operative durable left ventricular assist devices (LVAD). The average listing status at time of transplant was 3.3 +/- 1.4. The average time on the wait list was 147.44 +/- 195.85 days.
From March-June 2019, 31 total orthotopic heart transplants were performed. This includes three re-transplants and three multi-organ transplants (3 heart/kidney; 0 heart/liver; 0 heart/lung). The average recipient age was 47.5 +/- 13.3 years and 18 recipients were male and 13 were female. Twenty-three patients were Caucasian. Eight patients were African American. One patient was Asian-American. There were 15 blood type A recipients, five blood type B recipients, one blood type AB recipient and 10 blood type O recipients. Eight patients had pre-operative durable left ventricular assist devices (LVAD). The average listing status at time of transplant was 3.0 +/-.99. The average time on the wait list was 112.94 +/- 260.11 days. There was no significant difference in recipient demographic variables across groups except for race of the transplant recipients (p= 0.029) (TABLE 1).
Donor variables over these two time periods were not different (TABLE 2). From March-June 2020, the average donor age was 29.1 +/- 8.3 years and 30 donors were male and 13 were female. Thirty-one donors were Caucasian. Seven donors were African American. One donor was Hispanic. One donor was Native American. Ten donors were hepatitis C positive. Twenty donors were characterized as high risk. The average time of allograft travel to the recipient hospital was 88.49 +/- 53.5 minutes.
From March-June 2019, the average donor age was 32.0 +/- 8.8 years and 18 donors were male and 13 were female. Twenty-six donors were Caucasian. Three donors were African American. Two donors were Hispanic. Fifteen donors were hepatitis C positive. Seventeen donors were characterized as high risk. The average time of allograft travel to the recipient hospital was 87.87 +/- 36.05 minutes. In addition, there was no difference in the number of local versus imported organs over these two periods of time.
Of the 43 transplants performed between March-June 2020, 41 achieved 30-day survival. Four recipients needed post-operative continuous renal replacement therapy. The average total length of stay was 18.2 +/- 8.1 days and the average intensive care unit length of stay was 6.1 +/- 3.1 days. Four patients had primary graft dysfunction and six patients had rejection (2R or greater) at 30 days6.
Of the 31 transplants performed between March-June 2019, 30 achieved 30-day survival. Nine patients needed post-operative continuous renal replacement therapy. The average total length of stay was 23.0 +/- 13.4 days and the average intensive care unit length of stay was 11.0 +/- 8.7 days. Three patients had primary graft dysfunction and three patients had rejection (2R or greater) at 30 days. The only significant difference in recipient outcome was the incidence of continuous renal replacement therapy (p= 0.01) (Table 3).
There was no evidence of acute, post-operative infection of any recipient with COVID-19 during this time period.