Fraser Meg, Nzemenoh Bellony, Jackson Scott, Chaikijurajai Thanat, Halmosi Robert, Toth Kalman, Khan Wahab J, Alexy Tamas
Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN 55455, USA.
Department of Medicine, University of Minnesota, Minneapolis, MN 55455, USA.
J Cardiovasc Dev Dis. 2023 May 20;10(5):222. doi: 10.3390/jcdd10050222.
The COVID-19 pandemic and consequent social isolation prompted a surge in mental health disorders and substance use in the general population and, therefore, in potential organ donors. We aimed to evaluate if this led to a change in donor characteristics, including the mechanism and circumstance of death, and how this may have affected clinical outcomes following heart transplantation.
We identified all heart donors from the SRTR database between 18 October 2018 and 31 December 2021, excluding those who donated immediately after the US national emergency declaration. Donors were stratified into pre-COVID-19 (Pre-Cov; through 12 March 2020) and post-COVID-19 national emergency declaration cohorts (Post-Cov; 1 August 2020 through 31 December 2021) based on the heart procurement date. Relevant demographics, cause of death, and substance use history were collected in addition to graft cold ischemic time, the incidence of primary graft dysfunction (PGD), and recipient survival at 30 days post-transplant.
A total of 10,314 heart donors were identified; 4941 were stratified into the Pre-Cov and 5373 into the Post-Cov cohorts. There was no difference in demographics, but illicit drug use was significantly higher in the Post-Cov group, leading to an increased incidence of death from drug intoxication. Fatal gunshot wounds were also more common. Despite these changes, the incidence of PGD remained similar ( = 0.371), and there was no difference in 30 days recipient survival ( = 0.545).
Our findings confirm that COVID-19 had a major impact on mental health and psychosocial life with an associated increase in illicit substance use and fatal intoxication rates in heart transplant donors. These changes did not alter peri-operative mortality following heart transplantation. Future studies are needed to ensure that long-term outcomes remain unaffected.
新冠疫情及随之而来的社会隔离促使普通人群中心理健康障碍和物质使用激增，潜在器官捐献者亦是如此。我们旨在评估这是否导致了捐献者特征的变化，包括死亡机制和情况，以及这可能如何影响心脏移植后的临床结果。
我们从器官获取与移植网络（SRTR）数据库中确定了2018年10月18日至2021年12月31日期间的所有心脏捐献者，排除在美国发布国家紧急声明后立即进行捐献的那些人。根据心脏获取日期，将捐献者分为新冠疫情前（Cov前；截至2020年3月12日）和新冠疫情国家紧急声明后队列（Cov后；2020年8月1日至2021年12月31日）。除了移植物冷缺血时间、原发性移植物功能障碍（PGD）的发生率以及移植后30天接受者的生存率外，还收集了相关人口统计学数据、死亡原因和物质使用史。
共确定了10314名心脏捐献者；4941名被分层到Cov前队列，5373名被分层到Cov后队列。人口统计学方面没有差异，但Cov后组的非法药物使用显著更高，导致药物中毒死亡的发生率增加。致命枪伤也更常见。尽管有这些变化，但PGD的发生率仍然相似（P = 0.371），移植后30天接受者的生存率也没有差异（P = 0.545）。
我们的研究结果证实，新冠疫情对心理健康和社会心理生活产生了重大影响，心脏移植捐献者中非法物质使用和致命中毒率相应增加。这些变化并未改变心脏移植后的围手术期死亡率。需要进一步的研究来确保长期结果不受影响。
