Impact of COVID-19 Infection Among Heart Transplant Recipients: A Southern Brazilian Experience

Abstract

PurposeThe coronavirus-2019 (COVID-19) infection is associated with a high risk of complications and death among heart transplant recipients. However, most cohorts are from high-income countries, while data from Latin America are sparse.MethodsThis is a retrospective cohort of heart transplant recipients followed at a hospital in Rio Grande do Sul, Brazil, between March 1st 2020 and October 1st 2021.ResultsOf the 62 heart transplant recipients on follow-up, 21 (34%) were infected by COVID-19, 58 (36–63) years of age, 67% male, body mass index of 26 (23-29) kg/m2, 48% with hypertension, 43% with chronic kidney disease, 5% with diabetes, within 2 (1–4) years of post-transplant follow-up. At presentation, the main symptoms were fever (62%), myalgia (33%), cough (33%), headache (33%), and dyspnea (19%). Hospitalization was required for 13 (62%) patients, with a time from first symptoms to the admission of 5 (1–12) days. In 38%, supplementary oxygen was needed, 19% required intensive care, and 10% mechanical ventilation. Three (14%) were infected after at least a first dose of COVID-19 vaccine. The main complications were bacterial pneumonia (38%), renal replacement therapy (19%), sepsis (10%) and venous thromboembolism (10%). Immunosuppression therapy was modified in 48%, with a reduction in the majority (89%). Two (10%) patients died in the hospital due to refractory hypoxemia and multiple organ dysfunction. The incidence of COVID-19 among transplant patients was comparable to the general population in the State of Rio Grande do Sul with a peak in December 2020.ConclusionHeart transplant recipients shown a high rate of COVID-19 infection in Southern Brazil, with typical symptom presentation in most cases. There was an elevated rate of hospitalization, supplementary oxygen support, and complications. In-hospital lethality among infected heart transplanted recipients was similar to previously reported data worldwide despite the high rates of infection in Latin America.

Real‐world experience of tixagevimab‐cilgavimab pre‐exposure prophylaxis in orthotopic heart transplant recipients

“…[4][5][6] Due to immunosuppression and associated comorbidities, orthotopic heart transplant (OHT) recipients are at increased risk of adverse outcomes associated with COVID-19. [7][8][9] A recent study that evaluated the association between SARS-CoV-2 immunizations and clinical outcomes in OHT recipients demonstrated that unvaccinated patients had a case fatality rate of 9% compared to 4% in vaccinated OHT recipients. 10 Several monoclonal antibodies (mAb) targeting SARS-CoV-2 spike protein were authorized for early treatment of mild to moderate COVID-19, and their use has been associated with reduced rates of hospitalization and mortality in SOT recipients.…”

“…Due to immunosuppression and associated comorbidities, orthotopic heart transplant (OHT) recipients are at increased risk of adverse outcomes associated with COVID‐19 7–9 . A recent study that evaluated the association between SARS‐CoV‐2 immunizations and clinical outcomes in OHT recipients demonstrated that unvaccinated patients had a case fatality rate of 9% compared to 4% in vaccinated OHT recipients 10 …”

Evolution of the impact of the COVID‐19 pandemic on heart transplant recipients: Decreasing risk, improving perspective

“…Among the complications observed, acute renal failure and co‐infections were particularly frequent. However, the incidence of thrombosis was not as prevalent, possibly due to the fact that 20% of patients with pneumonia and 9.4% of those without were on chronic anticoagulation therapy, along with the widespread use of anticoagulation prophylaxis in at‐risk patients 36 . It is important to consider that HTr have a small, but not negligible, rate of re‐infection, even in patients with known humoral immunity, and these re‐infections can potentially be serious.…”

Dynamic Topic Modelling for Exploring the Scientific Literature on Coronavirus: An Unsupervised Labelling Technique

“…For 2020, the topic T 46 was labelled as "medium" and "social", and although there are no cross-domain documents for these dates, there are documents for another date on the effect of news coverage and online advertising on patients seeking information on aspirin, heart health, and stroke [73]. For the topic T 64 and T 93 one of the most relevant cross-domain documents talks about the impact of COVID-19 on heart transplant recipients [74].…”