Heart transplantation in the early phase of the COVID‐19 pandemic: A single‐center case series

Abstract

On February 26, 2020, the first case of community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States (US) was confirmed. 1 SARS-CoV-2 causes coronavirus disease 2019 (COVID-19), and on March 11, the World Health Organization declared COVID-19 a global pandemic. By May 27, 2020, SARS-CoV-2 had infected over 1.6 million people in the United States, resulting in over 100 000 deaths. 2 The ongoing pandemic has presented a challenging predicament for organ transplantation programs. The combination of a protracted asymptomatic incubation period of SARS-CoV-2 and the lack of capacity for rapid testing of potential donors to avoid transmission of SARS-CoV-2 were challenges to transplant programs. 3 Further, the effects of SARS-CoV-2 in highly immunosuppressed patients in the early post-transplant period are currently unclear. Nonetheless, it has been assumed that any significant viral infection in this patient cohort would be detrimental, which has been demonstrated in early reports. 4 In addition, cardiovascular disease has emerged as a risk factor for mortality with COVID-19. 5 Indeed, the number of patients inactivated on the heart transplant waitlist more than doubled between the weeks of March 8 and

Successful heart transplantation in a patient who recovered from COVID‐19

“…As a result, some transplant centers have been forced to decrease their ability to offer transplantation in the midst of the pandemic. This has resulted in an overall decrease in the number of transplants performed in the United States coupled with an increased number of inactive patients on the UNOS waiting list 1 …”

Heart transplant recipient 1‐year outcomes during the COVID‐19 pandemic

“…This triple therapy regimen was also utilized by centers in prior case series that showed favorable outcomes in the early postoperative period for patients transplanted at the start of the pandemic. 5,6 Therefore, we expected to have similar 1-year freedom from any treated rejection, acute antibody mediated rejection, and acute cellular rejection between the two groups which was seen in the current study. And although patients were transitioned to video visits after postoperative month 6, at home blood draws were conducted to adjust immunosuppression dosages accordingly and further help prevent rejection.…”

Two-Case Series of Heart Transplant at a Single Center in a SARS-CoV-2 Epicenter

“…An 87-patient study in China reported post-transplant patients experiencing virus-related morbidities comparable to those in the general population. [4][5][6] In our study, one patient was transiently seropositive at two months posttransplant but was asymptomatic throughout the following eight months. This suggests that patients transplanted during the pandemic may be at no greater risk than the general population throughout their perioperative course.…”

“…Under similar conditions, Hsu et alin Los Angeles performed eight successful heart transplants at the University of California early in the pandemic. 4 Regarding donor-to-recipient transmission risk, donor institutions confirmed SARS-CoV-2 negativity in both cases. Organ procurement was limited to single surgeon/restricted geographic radius.…”

“…1,2 Investigation has been minimal in patients transplanted after SARS-CoV-2's emergence, though short-term outcomes have been largely benign. [3][4][5] New Jersey rapidly became a SARS-COV-2 epicenter. State of emergency was declared on March 9, 2020.…”