Characteristics and Outcomes of Heart Transplant Recipients with Coronavirus-19 Disease

Marcondes‐Braga, Fabiana G.; Murad, Ciro Mancilha; Belfort, D. d.; Dantas, R.C.; Lira, M.S.; Aragão, Carlos Aurélio Santos; Siciliano, Roberta; Mangini, Sandrigo; Seguro, Luis Fernando Bernal da Costa; Campos, I.W.; Avila, M.S.; Bello, Manuel; Barone, Filippo; Strabelli, Tânia Mara Varejão; Gaiotto, Fábio Antônio; Bacal, F

doi:10.1016/j.healun.2021.01.1783

Cited by 3 publications

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“…The elevated number of infected individuals in the overall population and the impact on the health care systems could have contributed to the adverse outcomes. As for internationally reported data involving heart transplant patients with COVID-19 (4,(8)(9)(10)(11)(12)(13)(14)(15)(20)(21)(22)(23)(24), our data compared somewhat favorably with regards to lethality rates, being within reported ranges, despite very high COVID-19 infection rates in Brazil and Latin America (6).…”

Section: Discussionsupporting

confidence: 74%

“…The high proportion of heart transplant recipients infected with COVID-19 requiring hospitalization in our cohort highlights the increased risk for complications in this patient population. There was a wide range of time from initial presentation to hospital admission [median of 5 (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12) days]. This finding may be related to the small sample but may also suggest that some patients have a fast disease progression, while others have a slower course.…”

Section: Discussionmentioning

confidence: 99%

“…However, non-transplanted patients appear to have higher rates of typical symptoms, reaching >90% of fever and 80% of cough, especially among those that are hospitalized ( 2 , 5 , 6 ). As detailed in Table 3 , previously published cohorts reported a wide range of symptoms' frequency among heart transplant recipients infected with COVID-19, in whom fever ranged from 25 to 100% ( 8 – 11 ), and cough from 36 to 100% ( 9 , 10 , 12 – 14 ). Interestingly, we did not observe dyspnea to be a major complaint at the diagnosis, which was different from other studies.…”

Section: Discussionmentioning

confidence: 99%

“…Immunosuppression of heart transplant recipients favors severe forms of infection, but its reduction could lead to rejection episodes, a risk potentially exacerbated by the increase of cytokine release during COVID-19 infection ( 5 , 10 , 13 , 15 ). In our cohort, most patients had their immunosuppression therapy reduced and no rejection episodes were detected during the period.…”

Section: Discussionmentioning

confidence: 99%

“…In our cohort, most patients had their immunosuppression therapy reduced and no rejection episodes were detected during the period. Cardiac allograft rejection during symptomatic COVID-19 or in the post-infection period was reported only in one study, in which immunosuppression was decreased or withdrawn ( 10 ). The current strategy of reducing treatment seems to be safe, although there are no clinical trials evaluating immunosuppression approaches in this population to date, and it is yet unknown if such a strategy improves COVID-19 treatment and outcomes ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

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Impact of COVID-19 Infection Among Heart Transplant Recipients: A Southern Brazilian Experience

et al. 2022

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PurposeThe coronavirus-2019 (COVID-19) infection is associated with a high risk of complications and death among heart transplant recipients. However, most cohorts are from high-income countries, while data from Latin America are sparse.MethodsThis is a retrospective cohort of heart transplant recipients followed at a hospital in Rio Grande do Sul, Brazil, between March 1st 2020 and October 1st 2021.ResultsOf the 62 heart transplant recipients on follow-up, 21 (34%) were infected by COVID-19, 58 (36–63) years of age, 67% male, body mass index of 26 (23-29) kg/m2, 48% with hypertension, 43% with chronic kidney disease, 5% with diabetes, within 2 (1–4) years of post-transplant follow-up. At presentation, the main symptoms were fever (62%), myalgia (33%), cough (33%), headache (33%), and dyspnea (19%). Hospitalization was required for 13 (62%) patients, with a time from first symptoms to the admission of 5 (1–12) days. In 38%, supplementary oxygen was needed, 19% required intensive care, and 10% mechanical ventilation. Three (14%) were infected after at least a first dose of COVID-19 vaccine. The main complications were bacterial pneumonia (38%), renal replacement therapy (19%), sepsis (10%) and venous thromboembolism (10%). Immunosuppression therapy was modified in 48%, with a reduction in the majority (89%). Two (10%) patients died in the hospital due to refractory hypoxemia and multiple organ dysfunction. The incidence of COVID-19 among transplant patients was comparable to the general population in the State of Rio Grande do Sul with a peak in December 2020.ConclusionHeart transplant recipients shown a high rate of COVID-19 infection in Southern Brazil, with typical symptom presentation in most cases. There was an elevated rate of hospitalization, supplementary oxygen support, and complications. In-hospital lethality among infected heart transplanted recipients was similar to previously reported data worldwide despite the high rates of infection in Latin America.

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Section: Discussionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Impact of COVID-19 Infection Among Heart Transplant Recipients: A Southern Brazilian Experience

et al. 2022

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Is Early COVID-19 in Kidney Transplant Recipients Concerning Enough to Halt Transplantation? A Multicenter Comparative Analysis from India

Meshram

Kute

Patel

et al. 2021

Transplantation Proceedings

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Introduction: Limited data exists on the incidence and outcome of early coronavirus disease (COVID-19) in kidney transplantation recipients (KTR). Methods: A retrospective multicentre research was conducted across 12 centers of India. We explored the symptomatology, demographic, laboratory findings and outcome of COVID-19 within 30 days of transplantation. The outcome was compared with the overall KTR and waitlisted patients acquiring COVID-19. Results: The incidence of early COVID-19 was 2.6% (n =22) for the cumulative 838 renal transplants performed since nationwide lockdown in March 2020 till May 2021. Overall, 1049 KTR were diagnosed with COVID-19 and 2% of those had early COVID-19. The median age of the early COVID-19 cohort was 43(31-46) years. COVID-19 severity ranged from asymptomatic (18.2%), mild (59.1%), moderate (9.1%) and severe (13.6%). Among clinical symptoms, Dyspnea and Anosmia were frequent and in laboratory parameters neutrophil lymphocyte ratio, high sensitive C reactive protein and D- dimer were higher in patients requiring oxygen. The mortality in early COVID-19 was not higher than overall KTR (4.5% vs 8.5%; p-value: 1). COVID-19 severity (23.9% vs 15.7%; p-value: 0.0001) and mortality (15.5% vs 8.5%; p-value: 0.001) among waitlisted patients (n = 1703) were higher compared to overall KTR. Conclusion: We report higher burden of COVID-19 in waitlisted patients compared to KTR and a favorable outcome in early COVID-19 in KTR. Our report will help the transplant physicians in dealing with the ongoing dilemma of halting or resuming transplantation in the COVID-19 era.

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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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Characteristics and Outcomes of Heart Transplant Recipients with Coronavirus-19 Disease

Cited by 3 publications

References 0 publications

Impact of COVID-19 Infection Among Heart Transplant Recipients: A Southern Brazilian Experience

Impact of COVID-19 Infection Among Heart Transplant Recipients: A Southern Brazilian Experience

Is Early COVID-19 in Kidney Transplant Recipients Concerning Enough to Halt Transplantation? A Multicenter Comparative Analysis from India

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

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