Characteristics and Outcomes of Recipients of Heart Transplant With Coronavirus Disease 2019

Abstract

IMPORTANCERecipients of heart transplant (HT) may be at increased risk of adverse outcomes attributable to infection with coronavirus disease 2019 (COVID-19) because of multiple comorbidities and clinically significant immunosuppression.OBJECTIVE To describe the characteristics, treatment, and outcomes of recipients of HT with COVID-19. DESIGN, SETTING, AND PARTICIPANTSThis case series from a single large academic heart transplant program in New York, New York, incorporates data from between March 1, 2020, and April 24, 2020. All recipients of HT followed up by this center who were infected with COVID-19 were included. INTERVENTIONS Heart transplant and a confirmed diagnosis of COVID-19.MAIN OUTCOMES AND MEASURES The primary measure was vital status at end of study follow-up. Secondary measures included patient characteristics, laboratory analyses, changes to immunosuppression, and treatment administered for COVID-19.RESULTS Twenty-eight patients with HT received a confirmed diagnosis of COVID-19. The median age was 64.0 (interquartile range [IQR], 53.5-70.5) years, 22 (79%) were men, and the median time from HT was 8.6 (IQR, 4.2-14.5) years. Comorbid conditions included hypertension in 20 patients (71%), diabetes in 17 patients (61%), and cardiac allograft vasculopathy in 16 patients (57%). Twenty-two participants (79%) were admitted for treatment, and 7 (25%) required mechanical ventilation. Most (13 of 17 [76%]) had evidence of myocardial injury (median high-sensitivity troponin T, 0.055 [IQR, 0.0205-0.1345] ng/mL) and elevated inflammatory biomarkers (median peak high-sensitivity C-reactive protein, 11.83 [IQR,] mg/dL; median peak interleukin 6, 105 [IQR,] pg/mL). Among patients managed at the study institution, mycophenolate mofetil was discontinued in 16 patients (70%), and 6 (26%) had a reduction in the dose of their calcineurin inhibitor. Treatment of COVID-19 included hydroxychloroquine (18 patients [78%]), high-dose corticosteroids (8 patients [47%]), and interleukin 6 receptor antagonists (6 patients [26%]). Overall, 7 patients (25%) died. Among 22 patients (79%) who were admitted, 11 (50%) were discharged home, 4 (18%) remain hospitalized at the end of the study, and 7 (32%) died during hospitalization. CONCLUSIONS AND RELEVANCEIn this single-center case series, COVID-19 infection was associated with a case fatality rate of 25% in recipients of HT. Immunosuppression was reduced in most of this group of patients. Further study is required to evaluate the optimal approach to management of COVID-19 infection in the HT population.

A case series of novel coronavirus infection in heart transplantation from 2 centers in the pandemic area in the North of Italy

“…9−13 Ren et al 14 reported a low rate of suspected cases of SARS-CoV-2 infection and no death in a series of 87 heart transplant patients; however, none had a laboratory confirmation of infection. Latif et al 12 reported a case fatality rate of 25% in a series of 28 heart-transplanted patients with a confirmed diagnosis of COVID-19.…”

Different clinical presentations of two renal transplant recipients with coronavirus disease 2019: a case report

“…Review of the clinical courses showed that most of the transplant patients were managed successfully without progression of the disease. However, some other studies revealed that transplant recipients experienced more severe COVID-19 pneumonia and a more difficult recovery than their infected family members and those in the general population [21][22][23]. In a case series of 12 patients with a history of kidney transplantation in Iran [24], the fatality rate reached 67%, and the author concluded the majority of the clinical features in deceased cases were similar to those from other adult studies for the general population.…”

Clinical course and challenging management of early COVID-19 infection after heart transplantation: Case report of two patients

“…Recently, Latif et al described a single-center case series of 28 HTR with con rmed diagnosis of COVID-19 in the United states. The median time from HT was 8.6 years, and the case fatality rate was 25% [6].…”

“…In the current context of coronavirus disease 2019 (COVID- 19), the management of patients with endstage heart failure on the transplant waiting-list is challenging. To date, only few case reports or small case series of COVID-19 in heart transplant recipients (HTR) have been described in China, Spain, Germany, and the United States, with mainly HTR who were remote from transplant [1][2][3][4][5][6][7]. Herein, we report on two HTR who developed and ultimately died from severe COVID-19, a few days after their urgent transplant procedure (TP).…”