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

Abstract

Background There are limited data on Coronavirus disease 2019 (COVID-19) in solid organ transplant patients, especially in heart transplant recipients, with only a few case reports and case series described so far. Heart transplant recipients may be at particular high risk due to their comorbidities and immunosuppressed state. Case presentation This report describes the clinical course and the challenging management of early COVID-19 infection in two heart transplant recipients who tested positive for the SARS-CoV-2 virus in the perioperative period of the transplant procedure. The two patients developed a severe form of the disease and ultimately died despite the initiation of an antiviral monotherapy with hydroxychloroquine coupled with the interruption of mycophenolate mofetil. Conclusions These two cases illustrate the severity and poor prognosis of COVID-19 in the perioperative period of a heart transplant. Thorough screening of donors and recipients is mandatory, and the issue of asymptomatic carriers needs to be addressed.

SARS-CoV-2 infection in heart transplant recipients: a systematic literature review of clinical outcomes and immunosuppression strategies

“…Five databases were used to find 2818 articles related to COVID-19 infection in HT and heart-kidney transplant recipients. Thirty-three studies were then deemed eligible for inclusion in this review [ 7 – 39 ]. A PRISMA flow diagram detailing the process of identification, inclusion, and exclusion of studies is shown in Fig.…”

“…Of the thirty-three studies, eleven were retrospective case series [ 7 , 11 , 14 , 19 , 20 , 26 , 29 – 33 , 38 , 39 ], while twenty-two were case reports [ 8 – 10 , 12 , 13 , 15 – 18 , 21 – 25 , 27 , 28 , 34 – 37 ]. All were peer-reviewed.…”

Early report from the Pediatric Heart Transplant Society on COVID-19 infections in pediatric heart transplant candidates and recipients

“…While the literature for adult patients with heart transplants is limited to case reports and small case series, there is some suggestion that infection early after transplant may have an impact on outcomes ( 20 , 21 , 22 ). A US cohort of 28 adult heart transplant patients reported a 25% case fatality rate ( 15 ).…”

“…However, one-fifth of the patients were <1 year post transplant with one death in this group. This is an important group of patients to continue to monitor, given the reports of adults experiencing worse outcomes in the early phase post HTx ( 20 , 21 , 22 ) Whether reduction in immunosuppression is warranted in this specific group of patients is unclear.…”

Is Early COVID-19 in Kidney Transplant Recipients Concerning Enough to Halt Transplantation? A Multicenter Comparative Analysis from India

“… [28] Lima et al, showed negative impact of COVID-19 in five heart transplants. [29] Tchana-Sato et al reported two fatalities in perioperative COVID-19 heart transplantation with COVID-19 [30] Keller et al detailed a deceased donor lung transplant who acquired early covid-19 required mechanical ventilation. [31] Dale et al described two cases of early liver transplant who contracted severe COVID-19 and recovered.…”