COVID-19 among heart transplant recipients in Germany: a multicenter survey

Abstract

Aims Heart transplantation may represent a particular risk factor for severe coronavirus infectious disease 2019 (COVID-19) due to chronic immunosuppression and frequent comorbidities. We conducted a nationwide survey of all heart transplant centers in Germany presenting the clinical characteristics of heart transplant recipients with COVID-19 during the first months of the pandemic in Germany. Methods and results A multicenter survey of all heart transplant centers in Germany evaluating the current status of COVID-19 among adult heart transplant recipients was performed. A total of 21 heart transplant patients with COVID-19 was reported to the transplant centers during the first months of the pandemic in Germany. Mean patient age was 58.6 ± 12.3 years and 81.0% were male. Comorbidities included arterial hypertension (71.4%), dyslipidemia (71.4%), diabetes mellitus (33.3%), chronic kidney failure requiring dialysis (28.6%) and chronic-obstructive lung disease/asthma (19.0%). Most patients received an immunosuppressive drug regimen consisting of a calcineurin inhibitor (71.4%), mycophenolate mofetil (85.7%) and steroids (71.4%). Eight of 21 patients (38.1%) displayed a severe course needing invasive mechanical ventilation. Those patients showed a high mortality (87.5%) which was associated with right ventricular dysfunction (62.5% vs. 7.7%; p = 0.014), arrhythmias (50.0% vs. none; p = 0.012), and thromboembolic events (50.0% vs. none; p = 0.012). Elevated high-sensitivity cardiac troponin T-and N-terminal prohormone of brain natriuretic peptide were significantly associated with the severe form of COVID-19 (p = 0.017 and p < 0.001, respectively). Conclusion Severe course of COVID-19 was frequent in heart transplanted patients. High mortality was associated with right ventricular dysfunction, arrhythmias, thromboembolic events, and markedly elevated cardiac biomarkers.

COVID-19 and Heart Transplant: A Case Series and Review of the Literature

“…Symptoms are also similar to the general population including fever, cough, shortness of breath, and less commonly gastrointestinal. [2] , [3] , [4] However, it does seem that mortality rates in this subset of patients far exceed that in the general population based on some case series and is in the range of 25% - 33%. [2] , [3] , [4] It is unclear whether this increased mortality is related to the immunosuppressed state of patients, or to the fact that these patients are more likely to be older, with more comorbidities, and with more severe infection.…”

Impact of COVID-19 infection on the cardiovascular system: An evidence-based analysis of risk factors and outcomes

“…Another study was also conducted at the beginning of the pandemic. Still, this time in Germany, noted that heart transplant patients were presumed to be in a high-risk category for severe infection not only related to the chronic immunosuppression but also due to various comorbid diseases in heart transplant patients that are associated with a bad outcome with COVID-19 infection ( 93 ). This study cited comorbidities associated with the highest mortality in heart transplant patients as being “right ventricular dysfunction, arrhythmias, thromboembolic events, and markedly elevated cardiac biomarkers” ( 93 ).…”

“…Still, this time in Germany, noted that heart transplant patients were presumed to be in a high-risk category for severe infection not only related to the chronic immunosuppression but also due to various comorbid diseases in heart transplant patients that are associated with a bad outcome with COVID-19 infection ( 93 ). This study cited comorbidities associated with the highest mortality in heart transplant patients as being “right ventricular dysfunction, arrhythmias, thromboembolic events, and markedly elevated cardiac biomarkers” ( 93 ). Another study found that although presumed to have a bad course, the solid organ (heart and kidney) transplant patients followed in that study, who were on immunosuppression and who contracted COVID-19, had a mild course ( 94 ).…”

COVID-19 and the Cardiovascular System: A Review

“…52The majority of published studies on the management of SARS-CoV-2 infection in heart transplant recipients are in the form of case series with no randomised trial data. (53) In the acute phase of the SARS-CoV-2 infection, immunosuppression may be reduced or withheld. During that time, close monitoring of graft function is mandatory.…”