Clinical manifestations and outcomes of coronavirus disease‐19 in heart transplant recipients: a multicentre case series with a systematic review and meta‐analysis

Abstract

Summary Available data on clinical presentation and mortality of coronavirus disease‐2019 (COVID‐19) in heart transplant (HT) recipients remain limited. We report a case series of laboratory‐confirmed COVID‐19 in 39 HT recipients from 3 French heart transplant centres (mean age 54.4 ± 14.8 years; 66.7% males). Hospital admission was required for 35 (89.7%) cases including 14/39 (35.9%) cases being admitted in intensive care unit. Immunosuppressive medications were reduced or discontinued in 74.4% of the patients. After a median follow‐up of 54 (19–80) days, death and death or need for mechanical ventilation occurred in 25.6% and 33.3% of patients, respectively. Elevated C‐reactive protein and lung involvement ≥50% on chest computed tomography (CT) at admission were associated with an increased risk of death or need for mechanical ventilation. Mortality rate from March to June in the entire 3‐centre HT recipient cohort was 56% higher in 2020 compared to the time‐matched 2019 cohort (2% vs. 1.28%, P = 0.15). In a meta‐analysis including 4 studies, pre‐existing diabetes mellitus (OR 3.60, 95% CI 1.43–9.06, I 2 = 0%, P = 0.006) and chronic kidney disease stage III or higher (OR 3.79, 95% CI 1.39–10.31, I 2 = 0%, P = 0.009) were associated with increased mortality. These findings highlight the aggressive clinical course of COVID‐19 in HT recipients.

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

“…Bottio et al [ 4 ] in the Northern Italy series and Granger et al [ 41 ] from France have recently published multi-center registries documenting outcomes of HT recipients with SARS-CoV-2 infection. Older age, diabetes mellitus, peripheral vascular disease, previous percutaneous coronary intervention, lower eGFR, and higher NYHA functional class were significantly associated with in-hospital mortality and immunosuppressive drugs were reduced in all hospitalized patients.…”

“…Older age, diabetes mellitus, peripheral vascular disease, previous percutaneous coronary intervention, lower eGFR, and higher NYHA functional class were significantly associated with in-hospital mortality and immunosuppressive drugs were reduced in all hospitalized patients. The French series [ 41 ] observed an overall 56% excess year over year (from March–June 2019 to March–June 2020) excess mortality during the early outbreak of COVID among HT recipients. Diabetes mellitus or chronic kidney disease stage ≥ III was associated with greater risk of mortality.…”

SARS-CoV-2 Infection and Associated Cardiovascular Manifestations and Complications in Children and Young Adults: A Scientific Statement From the American Heart Association

“…Younger age and the low number of comorbidities in pediatric and young adult patients who otherwise are considered high risk for infectious complications likely contribute to the less severe implications of SARS-CoV-2 infections seen thus far compared with their older adult counterparts. 124 A multicenter review reported 26 pediatric solid-organ transplant recipients who contracted SARS-CoV-2 infection, including 6 heart transplant recipients. 125 Of the 6 heart recipients, 2 were hospitalized; neither required supplemental oxygen or a change in their immunosuppression regimen, and both were discharged to home.…”

SARS-CoV-2 messenger RNA vaccine antibody response and reactogenicity in heart and lung transplant recipients

“…Heart and lung transplant (HT/LT) recipients experience an elevated rate of severe illness due to SARS-CoV-2 infection ( 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 ). While two SARS-CoV-2 messenger RNA (mRNA) vaccines are currently available, solid organ transplant recipients (SOTR) were excluded from Phase 1-3 trials ( 9 , 10 ).…”