Overall results for children weighing <10 kg were inferior to those of their larger counterparts. This outcome was primarily influenced by congenital heart disease and presence of elevated pre-implant bilirubin levels. These factors should be taken into consideration at decision making because reasonable outcomes can be achieved in a select population of children weighing <10 kg.

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Pediatric VAD patients have post-transplant outcomes equal to that of medically supported patients, despite greater pre-implant illness severity. Post-transplant survival, hospital length of stay, infection and rejection were not affected by patient acuity at VAD implantation or VAD-related complications. Therefore, VAD as bridge to transplant mitigates severity of illness in children.

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As the COVID-19 pandemic continues to evolve, the medical community is faced with unexpected presentations in different patient populations. Data on heart transplant recipients are quite limited in adults 1-8 and lacking in children. One would expect that these patients are particularly vulnerable and at risk for more severe disease given their immunocompromised status and the high prevalence of comorbidities such as diabetes, hypertension, and chronic kidney disease. 9 However, it is currently unclear whether chronic immunosuppression is a risk factor for more severe disease and prolonged viral shedding, or it actually has a protective role by attenuating a dysregulated immune response and dampening the cytokine release syndrome that is associated with severe disease. 4 Consequently, the optimal management of immunosuppression upon diagnosis of COVID-19 disease remains unknown. We herein discuss four cases of young heart transplant recipients infected with COVID-19 and review the clinical presentation, treatment strategies, and short-term outcome.

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