Challenges in heart transplantation during COVID-19: A single-center experience

Abstract

BACKGROUND: Orthotopic heart transplantation (OHT) recipients may be particularly vulnerable to coronavirus disease 2019 (COVID-19). OHT during the pandemic presents unique challenges in terms of feasibility and safety. METHODS: Chart review was performed for consecutive OHT recipients with COVID-19 and waitlisted patients who underwent OHT from March 1, 2020 to May 15, 2020. RESULTS: Of the approximately 400 OHT recipients followed at our institution, 22 acquired COVID-19. Clinical characteristics included median age 59 (range, 49−71) years, 14 (63.6%) were male, and median time from OHT to infection was 4.6 (2.5−20.6) years. Symptoms included fever (68.2%), gastrointestinal complaints (55%), and cough (46%). COVID-19 was severe or critical in 5 (23%). All patients had elevated inflammatory biomarkers. Immunosuppression was modified in 85% of patients. Most (n = 16, 86.4%) were hospitalized, 18% required intubation, and 14% required vasopressor support. Five patients (23%) expired. None of the patients requiring intubation survived. Five patients underwent OHT during the pandemic. They were all males, ranging from 30 to 59 years of age. Two were transplanted at United Network of Organ Sharing Status 1 or 2, 1 at Status 3, and 2 at Status 4. All were successfully discharged and are alive without allograft dysfunction or rejection. One contracted mild COVID-19 after the index hospitalization. CONCLUSION: OHT recipients with COVID-19 appear to have outcomes similar to the general population hospitalized with COVID-19. OHT during the pandemic is feasible when appropriate precautions are taken. Further study is needed to guide immunosuppression management in OHT recipients affected by COVID-19.

Prognostic Impact of Prior Heart Failure in Patients Hospitalized With COVID-19

“…Future studies are needed to understand the impact of telemonitoring on long-term care and outcomes for this population. Among patients with severe HF, weighing the risk of exposure to COVID-19 against the benefit of life-saving therapies, such as mechanical circulatory support and heart transplantation, is particularly relevant and must be carefully considered on a case-by-case basis ( 39 ). Finally, understanding the mechanisms that underlie the high risk of complications and mortality among patients with HF begs the question of whether specific therapies to combat acute infection in COVID-19 should be used based on the history of HF.…”

Clinical course and challenging management of early COVID-19 infection after heart transplantation: case report of two patients

“…Since these initial reports, other papers describing the clinical course of COVID-19 in HTR have been published from Germany and the United States. They also featured HTR who were remote from transplant and were mostly receiving relatively low-dose maintenance immunosuppression [ 2 , 4 , 5 , 7 – 9 ]. Recently, Latif et al described a single-center case series of 28 HTR with a confirmed diagnosis of COVID-19 in the United States.…”

“…Singhvi et al also described a single -center case series of 22 HTR in the disease epicenter in New York. The median time from HT was 4.6 years, and the overall mortality was 22.7%, reaching 26.3% in hospitalized patients [ 9 ]. Finally, Rivinius et al reported 21 HTR with COVID-19 in a recent nation-wide survey of all HT centers in Germany during the first months of the pandemic.…”

“…The limited data published so far have shown that the clinical presentation of COVID-19 in those patients did not differ from non-transplant patients or other solid organ transplant recipients [ 1 , 2 , 5 , 6 , 8 ]. However, the case fatality rate in some case series varied from 23% to up to 33% [ 6 , 8 , 9 ]. Newly HTR constitute a particularly vulnerable cohort for severe COVID-19 infection due to high levels of immunosuppression and frequent comorbidities.…”

A review of cardiac involvement in COVID-19 infection

“…Studies show that the risk of COVID-19 infection in heart transplant recipients is not higher than the general population if proper precautions are taken. 52 Since few studies have been done in this population, the differences in symptoms, laboratory tests, and radiographic features have not been determined. 53 Also, solid organ transplantation (SOT) recipients such as heart transplant recipients are at greater risk of COVID-19 because of their potential anti-rejection immunosuppressive regimens.…”