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

Abstract

COVID19 has resulted in many challenges in patient care especially high-risk populations such as heart transplant patients. Patients with heart transplant experience a significantly higher mortality rate with COVID19 infection, and management is based on extrapolation from clinical trials done on non-transplant patients, and from clinical experience. Here we report four cases of heart transplant patients who presented in late 2020 with COVID19 infection. Patients presented with symptoms similar to those seen in the general population. All four patients were admitted to the hospital, and they were all treated with dexamethasone. In addition, two patients received remdesivir. Immunosuppressive medications were adjusted to maintain adequate levels of immunosuppression, but at the same time allowing for an adequate immune response against the infection. All patients were discharged alive from the hospital. We then performed a literature review on studies that included heart transplant patients who developed the infection, and suggest a standardized management approach accordingly.

Low mortality in SARS‐CoV‐2 infected heart transplant recipients at a single center

“…Among 28 cases of COVID‐19, 15 (54%) were admitted to the hospital for closer monitoring (Table 3, Figure 1). The most common presenting symptoms were cough (36%), fevers (25%), gastrointestinal symptoms (25%), shortness of breath (21%), loss of taste/smell (21%), and myalgias (7%), which is similar to the presenting symptoms reported in other studies on HT recipients 1–3,7–11,15–17 and in the general population 12,13 . Atypical symptoms were also quite common (reported in 46% of patients) and included chills, generalized pain and weakness, dizziness, sore throat, altered mental status, chest pain, headache, diffuse tingling, and rhinorrhea.…”

SARS-CoV-2 infection in heart transplant recipients: a systematic literature review of clinical outcomes and immunosuppression strategies

“…Of the thirty-three studies, eleven were retrospective case series [ 7 , 11 , 14 , 19 , 20 , 26 , 29 – 33 , 38 , 39 ], while twenty-two were case reports [ 8 – 10 , 12 , 13 , 15 – 18 , 21 – 25 , 27 , 28 , 34 – 37 ]. All were peer-reviewed.…”

“… Does the case report provide take away lessons? Total score Ahluwalia et al [ 11 ] ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 100% Ammirati et al [ 12 ] ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 100% Berg et al [ 28 ] ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 100% Ballout et al [ 29 ] ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 100% Bosch et al [ 13 ] ✓ ✓ X X X X ✓ ✓ 50% Carraffa et al [ 14 ] ✓ ✓ ✓ ✓ ✓ ✓ ✓ ✓ 100% ...…”

The Immunology of SARS-CoV-2 Infection and Vaccines in Solid Organ Transplant Recipients

“…A reduction of immunosuppression with supportive treatment, including convalescent plasma, remdesivir, and dexamethasone, resulted in the resolution of her symptoms within days [ 83 ]. Additionally, two heart transplant recipients were successfully treated with a combination of dexamethasone and remdesivir [ 84 ].…”

“…A case series of four heart transplant recipients showed that they were successfully treated with dexamethasone (with the addition of remdesivir in two patients) [ 84 ]. In a cohort of 32 lung transplant recipients with moderate/severe COVID-19, the mortality rate was 34%.…”