Cardiac transplant recipient with COVID-19 induced acute hypoxic respiratory failure: a case report

Abstract

Background Heart transplant recipients represent a particularly vulnerable patient population to the novel coronavirus disease 2019 (COVID-19) due to chronic immunosuppression and high rates of comorbidities. Currently, data are limited and evidence to guide management of heart transplant recipients with COVID-19 is sparse. In this case report, we provide a summary of the current literature as well as an in-depth analysis of our clinical decision-making. Case summary A 67-year-old female who underwent cardiac transplantation 1 year prior was found to have acute hypoxic respiratory failure due to COVID-19. Her immunosuppressant medications were modulated with discontinuation of mycophenolate and titration of tacrolimus troughs with a goal of 6–10 ng/dL. She was administered supportive treatment including convalescent plasma, remdesivir, and dexamethasone, in addition to antibiotic treatment that resulted in resolution of her symptoms within a matter of days despite her precarious disposition. Discussion This case demonstrates that it can be safe and efficacious to modulate immunosuppressant medications in cardiac transplant recipients in accordance with recommendations made by the International Society of Heart and Lung Transplantation. This case additionally demonstrates that aspects of the current literature regarding the management of COVID-19 can be safely extrapolated to cardiac transplant recipients. Providing supportive care with dexamethasone, remdesivir, and convalescent plasma as indicated can be beneficial in cardiac transplant recipients; although, the current literature regarding convalescent plasma and remdesivir is conflicting.

COVID-19 Convalescent Plasma for the Treatment of Immunocompromised Patients: A Systematic Review and Meta-analysis

“…For these exploratory analyses, 13 uncontrolled large case series without individual patient data enrolling 358 participants were included in descriptive analysis . In this study, 125 case reports or case series enrolling 265 participants were included for patient-level exploratory analyses. One study was included in both the descriptive analysis and the individual patient data analysis because individual patient data were available only for a subgroup of patients.…”

The Immunology of SARS-CoV-2 Infection and Vaccines in Solid Organ Transplant Recipients

“…A case of a 67-year-old female with respiratory failure that was attributed to COVID-19 was described 1 year after cardiac transplantation. A reduction of immunosuppression with supportive treatment, including convalescent plasma, remdesivir, and dexamethasone, resulted in the resolution of her symptoms within days [ 83 ]. Additionally, two heart transplant recipients were successfully treated with a combination of dexamethasone and remdesivir [ 84 ].…”