COVID-19 and Heart Transplantation. Initial Experience in a Tertiary Hospital

Abstract

Introduction : COVID 19 is a viral infectious disease caused by the SARS-CoV-2 virus that is affecting the entire world population. The objective of this study is to analyze the repercussion of the disease in a group of patients at risk such as heart transplants. Material and method : From February 2020 to February 2021, heart transplant patients diagnosed with COVID 19 were consecutively included. The total number of transplants in outpatient follow-up at that time was 381. 3 levels of infection were determined. A) Asymptomatic patients or with trivial symptoms without the need for hospital admission (6 patients). B) Patients admitted to the hospital for respiratory symptoms (12 patients). C) Patients with severe symptoms and need for admission to the Critical Care Unit (2 patients). At each risk level, medical performance was different. Thus, group A: Close control, no therapeutic modification. Group B: Reduction of calcineurin inhibitor (CNI) and substitution of mycophenolate mofetil (MMF) for everolimus (EVE). Group C: Reduction of ICN and withdrawal of MMF. Results : The prevalence of infection in the serie was 5.2%. Most of the patients admitted presented a pathological chest X-ray with fever, cough, dyspnea, or vomiting. The change in immunosuppression performed in group 2 patients was well tolerated and there was no graft rejection. Antiviral treatment was little used. However, boluses of steroids and some antibiotics were used frequently. The need for supplemental oxygen was 50% in group 2 and 100% in group 3. Conclusions : A significant number of transplant patients will be affected by COVID19 (5.3%). The management of the infection will depend on the severity of the infection and must be based on a balance between reduction and adjustment of immunosuppression, strict control of the cardiological situation, and treatment of the infection.

Editorial: cardiovascular anaesthesiology

“…These categories are, of course, intertwined and often difficult to parse out through retrospective analysis or even diagnostically in individual patients. In patients with end-stage heart failure (pre or posttransplant), for example COVID-19 may exacerbate end-stage heart failure and could be more easily contracted in immunosuppressed posttransplant patients [4]. Furthermore, in those diagnosed with COVID, there would likely be adjustments in immunosuppression, alterations in care to reduce the risk of viral spread and modifications to the organ donation process itself [5].…”