First cases of COVID-19 in heart transplantation from China

Cardiovascular Considerations for Patients, Health Care Workers, and Health Systems During the COVID-19 Pandemic

“…In addition to the mechanisms by which COVID-19 can affect patients with CVD risk factors, it is also important to consider COVID-19 in the context of an especially vulnerable group of patients, such as individuals awaiting or post heart transplantation. There are now case reports of COVID-19 infection among heart transplant patients (38,39).Two heart transplant patients in China, one with mild and one with severe disease, presented with symptoms typical of COVID-19 disease. Both were managed by withholding baseline immunosuppressive regimens and treating aggressively with high dose steroids, intravenous immunoglobulin, and antibiotics, and both survived without evidence of allograft rejection.…”

“…The ACC Clinical Bulletin provides a practical clinical summary about key implications and recommendations for CV care of COVID-19 patients (88). The ESC Council on Hypertension and European Society of Hypertension statements acknowledge the questions regarding ACEi and ARB therapy in the setting of COVID-19 patients (38,89). These societies as well as a number of others agree that further data would be vital to inform decisions on adjusting regimens of these agents in the setting of this outbreak (38,(89)(90)(91)(92).…”

“…The ESC Council on Hypertension and European Society of Hypertension statements acknowledge the questions regarding ACEi and ARB therapy in the setting of COVID-19 patients (38,89). These societies as well as a number of others agree that further data would be vital to inform decisions on adjusting regimens of these agents in the setting of this outbreak (38,(89)(90)(91)(92). Moving forward, these important CV societies among other large physician groups and health systems will be critical allies to advance the knowledge generation and CV care in patients infected with this virus.…”

COVID-19 illness in native and immunosuppressed states: A clinical–therapeutic staging proposal

“…The early reports in heart transplantation suggest that symptom expression during the phase of establishment of infection are similar to non-immunosuppressed individuals; however, in limited series the second wave determined by the host-inflammatory response appears to be milder, possibly due to the concomitant use of immuno-modulatory drugs. 5,6 Similarly, an epidemiological study from Wuhan in a cohort of 87 patients suggests that precautionary measures of social distancing, sanitization and general hygiene allow heart transplant recipients to experience a low rate of COVID-19 illness. 7 We do not of course, know if they are asymptomatic carriers, since in this survey-based study universal testing during the early 3 months was not employed.…”

Dilemma of organ donation in transplantation and the COVID-19 pandemic

“…One report of 2 cases of COVID-19 in heart transplant recipients in China suggested that the disease was manifest in a manner similar to that expected in the general population and did not progress into the hyperinflammation stage of the disease, with recovery in both cases. 3,4 Another cohort study of 87 heart transplant recipients over the first 3 months of the pandemic (December 2019−February 2020) suggested that precautionary measures of social distancing, sanitization, and hygiene resulted in no cases of confirmed diagnosis of COVID-19, without an increased incidence of other infection or allograft-related complications. 5 One area that remains unaddressed is how to assess an organ donor for cardiothoracic transplantation during the exposure opportunity for SARS-CoV-2 and the potential impact on teams procuring the organ and transplanting it and subsequently on the recipient.…”