Characteristics and Outcomes of Heart Transplant Recipients With Coronavirus-19 Disease in a High-volume Transplant Center

Marcondes‐Braga, Fabiana G.; Murad, Ciro Mancilha; Belfort, Deborah de Sá Pereira; Dantas, Rafael C T; Lira, Maria Tereza S S; Aragão, Carlos Aurélio Santos; Siciliano, Rinaldo Focaccia; Mangini, Sandrigo; Seguro, L. F. B. C.; Campos, I.W.; Avila, M.S.; Bello, Mariana V O; Santos, Fernanda B A Dos; Strabelli, Tânia Mara Varejão; Gaiotto, Fábio Antônio; Bacal, Fernando

doi:10.1097/tp.0000000000003770

Cited by 17 publications

(19 citation statements)

References 30 publications

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“…Earlier studies have shown kidney, 7 , 10 , 21 lung, 26 , 27 and heart 28 transplant recipients to be at high COVID‐19 risk compared to non‐SOT patients, and liver transplant recipients to be at the same or lower risk than the general non‐SOT population for reasons unknown. 29 , 30 However, this is the first large‐scale analysis to compare COVID‐19 outcomes directly between different allograft types.…”

Section: Discussionmentioning

confidence: 98%

Sex and organ-specific risk of major adverse renal or cardiac events in solid organ transplant recipients with COVID-19

Vinson

Dai

Agarwal

et al. 2022

American Journal of Transplantation

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While older males are at the highest risk for poor coronavirus disease 2019 (COVID‐19) outcomes, it is not known if this applies to the immunosuppressed recipient of a solid organ transplant (SOT), nor how the type of allograft transplanted may impact outcomes. In a cohort study of adult (>18 years) patients testing positive for COVID‐19 (January 1, 2020‐June 21, 2021) from 56 sites across the United States identified using the National COVID Cohort Collaborative (N3C) Enclave, we used multivariable Cox proportional hazards models to assess time to MARCE after COVID‐19 diagnosis in those with and without SOT. We examined the exposure of age‐stratified recipient sex overall and separately in kidney, liver, lung, and heart transplant recipients. 3996 (36.4%) SOT and 91 646 (4.8%) non‐SOT patients developed MARCE. Risk of post‐COVID outcomes differed by transplant allograft type with heart and kidney recipients at highest risk. Males with SOT were at increased risk of MARCE, but to a lesser degree than the non‐SOT cohort (HR 0.89, 95% CI 0.81–0.98 for SOT and HR 0.61, 95% CI 0.60–0.62 for non‐SOT [females vs. males]). This represents the largest COVID‐19 SOT cohort to date and the first‐time sex‐age–stratified and allograft‐specific COVID‐19 outcomes have been explored in those with SOT.

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Section: Discussionmentioning

confidence: 98%

Sex and organ-specific risk of major adverse renal or cardiac events in solid organ transplant recipients with COVID-19

Vinson

Dai

Agarwal

et al. 2022

American Journal of Transplantation

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“…Heart and lung transplant (HT/LT) recipients experience an elevated rate of severe illness due to SARS-CoV-2 infection ( 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ). While two SARS-CoV-2 messenger RNA (mRNA) vaccines are currently available, solid organ transplant recipients (SOTR) were excluded from Phase 1-3 trials ( 9 , 10 ).…”

Section: Introductionmentioning

confidence: 99%

SARS-CoV-2 messenger RNA vaccine antibody response and reactogenicity in heart and lung transplant recipients

Hallett

Greenberg

Boyarsky

et al. 2021

The Journal of Heart and Lung Transplantation

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Background: While several studies have observed that solid organ transplant recipients experience diminished antibody responses to SARS-CoV-2 mRNA vaccination, data specific to heart and lung transplant (HT/LT) recipients remains sparse. Methods: US adult HT and LT recipients completed their vaccine series between January 7 and April 10, 2021. Reactogencity and SARS-CoV-2 anti-spike antibody were assessed after a priming dose (D1) and booster dose (D2). Modified Poisson regression with robust variance estimator was used to evaluate associations between participant characteristics and antibody development. Results: Of 134 heart recipients, there were 38% non-responders (D1-/D2-), 48% booster responders (D1-/D2+), and 14% priming dose responders (D1+/D2+). Of 103 lung recipients, 64% were non-responders, 27% were booster responders, and 9% were priming dose responders. Lung recipients were less likely to develop antibodies (p<0.001). Priming dose antibody response was associated with younger recipient age (p=0.04), transplant-to-vaccination time ≥ 6 years (p<0.01), and lack of anti-metabolite maintenance immunosuppression (p<0.001). Pain at injection site was the most commonly reported reaction (85% after D1, 76% after D2). Serious reactions were rare, the most common being fatigue (2% after D1 and 3% after D2). No serious adverse events were reported. Conclusions: HT and LT recipients experienced diminished antibody response following vaccination; reactogenicity was comparable to that of the general population. LT recipients may exhibit a more impaired antibody response than HT recipients. While current recommendations are to vaccinate eligible candidates and recipients, further studies characterizing the cell-mediated immune response and clinical efficacy of these vaccines in this population are needed.

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“…Although the study by Mohanka et al is small, it offers hope as outcomes are better than originally reported in lung transplant recipients. 4 , 5 , 19 , 20 , 21 Compared with earlier reports of mortality approaching 30%, in a more current series of 2307 solid organ transplant recipients with COVID-19 (8% lung transplant and 11% heart transplant recipients), 30-day mortality was 4.8%. 22 However, while the mortality of COVID-19 in lung transplant recipients may not be as high as originally feared, ongoing issues remain regarding the potential for long-term effects on allograft function, including acceleration of chronic allograft loss, as seen with other viral respiratory tract infections.…”

Section: Covid-19 In Lung Transplantationmentioning

confidence: 82%

“… 2 , 3 However, in subsequent reports, heart and lung transplant recipients fared worse than non-transplant patients, with an observed mortality of 20-30%. 4 , 5 Two articles in the current issue of the Journal of Heart and Lung Transplantation offer greater insight into the clinical characteristics and outcomes of heart 6 and lung 7 transplant recipients infected with SARS-CoV-2.…”

mentioning

confidence: 99%

Covid-19 in recipients of heart and lung transplantation: Learning from experience

Kittleson

Chambers

Cypel

et al. 2021

The Journal of Heart and Lung Transplantation

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This is a PDF file of an article that has undergone enhancements after acceptance, such as the addition of a cover page and metadata, and formatting for readability, but it is not yet the definitive version of record. This version will undergo additional copyediting, typesetting and review before it is published in its final form, but we are providing this version to give early visibility of the article. Please note that, during the production process, errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.

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Characteristics and Outcomes of Heart Transplant Recipients With Coronavirus-19 Disease in a High-volume Transplant Center

Abstract: Continuous values are presented as median (interquartile range) and categorical ones as n (%). COVID-19, coronavirus disease 2019; IQR, interquartile range.

Cited by 17 publications

References 30 publications

Sex and organ-specific risk of major adverse renal or cardiac events in solid organ transplant recipients with COVID-19

Sex and organ-specific risk of major adverse renal or cardiac events in solid organ transplant recipients with COVID-19

SARS-CoV-2 messenger RNA vaccine antibody response and reactogenicity in heart and lung transplant recipients

Covid-19 in recipients of heart and lung transplantation: Learning from experience

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