COVID‐19 in heart transplant patients: Case reports from Brazil

Abstract

Introduction The COVID‐19 pandemic continues, with a late hyperinflammatory phase. The immunosuppressive therapy used in heart transplant patients, in theory, could reduce inflammation thus benefitting patients with COVID‐19. So far, however, there is still very little literature on this subject. Methods This is a single‐center retrospective study. We described laboratory parameters and clinical outcomes from 11 heart transplant patients with COVID‐19 assisted at Dante Pazzanese Institute of Cardiology between March and July 2020. Results Patients with ages between 35 to 79 years, and heart transplantation occurred from 3 to 264 months. The main comorbidities were diabetes mellitus (9/11; 81.8%), hypertension (10/11; 90.9%), and chronic renal disease (6/11; 54.5%). Cyclosporine A was used in 10 (90.9%) patients, mycophenolate mofetil in 9 (81.8%), and mTOR inhibitor in 5 (45.5%). Fever and cough were observed in 8 (72.7%) patients, and dyspnea and gastrointestinal symptoms in 5 (45.5%). Lymphopenia was observed in 10 (90.9%) and thrombocytopenia in 5 (45.5%). The higher level of troponin associated with chest tomography above 50% infiltrates of ground‐glass opacity (GGO) was observed in those with the worst outcomes. Nine patients needed intensive care, and hospital stay ranged from 4 to 21 days, with 2 (18.2%) patients requiring vasopressor drugs and mechanical ventilation, and three patients (27.3%) dying due to COVID‐19 complications. Conclusion Heart transplant patients had the similar symptoms and outcomes as general population; immunosuppressive therapy seems not to have protected them. Patients who presented higher levels of troponin and D‐dimer, associated to greater GGO pulmonary infiltrates had worse outcomes. More studies with larger cohorts may clarify immunosuppressive effects on COVID‐19 outcomes.

Mucormycosis as SARS-CoV2 sequelae in kidney transplant recipients: a single-center experience from India

“…There is an extensive literature in the context of clinical profile and outcome of COVID-19 in SOT [14] including kidney [15][16][17], liver [18], lung [19], and heart [20,21]. Transplantation activity ceased around the world during the COVID-19 peak, but it is estimated that postponing transplantation will result in excess of deaths [22] and hence depending on the COVID-19 surge and available resources, the transplantation should be resumed.…”

“…Mild cases (73% vs 43%; p-value = 0.1) were higher and there were fewer cases (20% vs 9%; p-value = 0.69) with severe COVID-19 in post-COVID-19 mucormycosis. Among the laboratory profile, lymphopenia [12 (10-18) vs 20 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26); p-value = 0.15] and higher neutrophil-lymphocyte ratio [7 (4.6-8.3) vs 3.85 (3.3 -5.8); p-value = 0.5] was more associated with post-COVID-19 mucormycosis.…”