COVID‐19 in heart transplant recipients during February–August 2020: A systematic review

Background. Solid organ transplant recipients (SOTr) are at increased risk for severe disease from coronavirus disease 2019 (COVID-19) compared with non-SOTr. Methods. We performed a retrospective cohort study between March 1, 2020, and March, 30, 2021, in an integrated healthcare system with 4.3 million members aged ≥18 y including 5126 SOTr. Comparisons in COVID-19 mortality, hospitalization, and incidence were made between SOTr and non-SOTr, and between different SOTr organs. Multivariate analysis was performed to identify risk factors for COVID-19 mortality and hospitalization. Results. There were 600 SOTr (kidney, liver, heart, and lung) with COVID-19. Per person-year incidence of COVID-19 among SOTr was 10.0% versus 7.6% among non-SOTr (P < 0.0001). Compared with uninfected SOTr, infected SOTr were older (57.1 ± 14.0 versus 45.7 ± 17.9 y, P < 0.001), predominantly Hispanic/Latino (58.8% versus 38.6%, P < 0.0001), hypertensive (77.0% versus 23.8%; P < 0.0001), and diabetic (49.6% versus 13.0%; P = 0.0009). Compared with non-SOTr, infected SOTr had higher hospitalization (39.5% versus 6.0%; P < 0.0001), intensive care unit admission (29.1% versus 15.5%; P < 0.0001), and mortality (14.7% versus 1.8%; P < 0.0001) from COVID-19. Older age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.05-1.10), male gender (HR, 1.79; 95% CI, 1.11-2.86), and higher body mass index (HR, 1.04; 95% CI, 1.00-1.09; P = 0.047) were associated with increased mortality from COVID-19, whereas race, diabetes, and number/type of immunosuppressive medications were not. Among the different SOTr, COVID-19 mortality risk was lowest in liver recipients (HR, 0.34; 95% CI, 0.16-0.73) and highest in lung recipients (HR, 1.74; 95% CI, 0.68-4.42). Conclusions. SOTr have higher rates of hospitalization and mortality from COVID-19 compared with the general population. Among the SOTr, the incidence and outcomes were distinct among different transplantation types.

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“…15,21,25,28-30 Heart recipient mortality was significantly lower than in lung recipients in our cohort, which is similar to other reports. 31-33…”

Section: Discussionmentioning

confidence: 99%

Incidence, Risk Factors, and Outcomes of COVID-19 Infection in a Large Cohort of Solid Organ Transplant Recipients

et al. 2022

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“…These rates are consistent with those in kidney and liver transplant recipients [ 68 – 70 ]. Among 415 heart transplant recipients, 34% had severe and 14% critical COVID-19, while 23% required ICU admission and 16% mechanical ventilation [ 71 ]. In a systematic review of SOTRs that included 37 articles, all-cause mortality was 19%, which varied by transplant type [ 65 ].…”

Section: Outcomes In Specific Immunocompromised Conditionsmentioning

confidence: 99%

“…However, mortality is generally consistent across transplantation type, including kidney and liver transplant recipients [ 68 – 70 , 72 , 73 ]. COVID-19–associated mortality of 24–26% was reported in two studies of 39 and 415 heart transplant recipients, respectively; diabetes mellitus and stage 3 or higher CKD were associated with increased mortality in one study [ 71 , 74 ]. A systematic review in 5559 kidney transplant recipients found those who died from COVID-19 were older, had a shorter time since transplantation, or were living in Asia–Pacific or Europe (vs. the United States) [ 68 ].…”

Section: Outcomes In Specific Immunocompromised Conditionsmentioning

confidence: 99%

Immune Response to COVID-19 and mRNA Vaccination in Immunocompromised Individuals: A Narrative Review

Napuri¹,

Curcio

Swerdlow

et al. 2022

Infect Dis Ther

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Immunocompromised individuals are at high risk of poor coronavirus disease 2019 (COVID-19) outcomes and demonstrate a lower immune response to COVID-19 vaccines, including to the novel mRNA vaccines that have been shown to elicit high neutralizing antibody levels. This review synthesized available data on the immune response to COVID-19 and critically assessed mRNA COVID-19 vaccine immunogenicity in this vulnerable subpopulation. Patients with various immunocompromising conditions exhibit diverse responses to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and COVID-19 severity and mortality, and available vaccines elicit lower immune responses, particularly in solid organ transplant recipients. Strategies to improve vaccine responses in immunocompromised individuals are being implemented in vaccine recommendations, including the use of a third and fourth vaccine dose beyond the two-dose series. Additional doses may enhance vaccine effectiveness and help provide broad coverage against emerging SARS-CoV-2 variants. Continued investigation of vaccines and dosing regimens will help refine approaches to help protect this vulnerable subpopulation from COVID-19.

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“…Heart transplant (HTX) recipients constitute a high-risk population of patients in the setting of COVID-19. 7 - 9 In addition to harboring higher number of comorbidities, 10 HTX patients have a suppressed immune state, which has been a controversial risk factor for the development of more severe COVID-19 or poor clinical outcomes. 7 , 8 , 11 …”

Section: Introductionmentioning

confidence: 99%

“…7-9 In addition to harboring higher number of comorbidities, 10 HTX patients have a suppressed immune state, which has been a controversial risk factor for the development of more severe COVID-19 or poor clinical outcomes. 7,8,11…”

Section: Introductionmentioning

confidence: 99%

Immune Response to SARS-CoV-2 Vaccine among Heart Transplant Recipients: A Systematic Review

Shoar

Prada-Ruiz

Patarroyo‐Aponte

et al. 2022

Clin Med Insights Circ Respir Pulm Med

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Background Heart transplant (HTX) recipients are at a significantly higher risk of adverse clinical outcomes, due to chronic immunosuppression and co-existence of other chronic conditions, when contracting the SARS-CoV-2 infection. Although vaccination against SARS-CoV-2 is currently the most promising measure for the prevention of severe Coronavirus Disease 2019 (COVID-19) among solid organ transplant recipients, the extent of immune response and its protective efficacy among patients receiving HTX has not been sufficiently studied. Methods We performed a systematic review of the literature by inquiring PubMed/Medline to identify original studies among HTX recipients, who had received at least one dose of the SARS-CoV-2 vaccine. Data on the measured humoral or cellular immune response was collected from all the eligible studies. Factors associated with a poor immune response were further investigated within these studies. Results A total of 12 studies comprising 563 HTX recipients were included. The average age of the study participants was 60.8 years. Sixty four percent of the study population were male. Ninety percent of the patients had received an mRNA vaccine (Pfizer/ BNT162b2 or Moderna/mRNA-1273). A positive immune response to SARS-CoV-2 vaccine was variably reported in 0% to 100% of the patients. Older age (> 65 years), vaccine dose (first, second, or third), time since HTX to the first dose of the vaccine, the time interval between the latest dose of the vaccine and measurement of the immune response, and the type of immunosuppressive regimen were all indicated as potential determinants of a robust immune response to the SARS-CoV-2 vaccination. Conclusion HTX recipients demonstrate a weaker immune response to the vaccination against SARS-CoV-2 compared to the general population. Older age, anti-metabolite agents such as mycophenolate mofetil, and vaccination during the first year following the HTX have been indicated as potential determinants of a poor immune response.

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COVID‐19 in heart transplant recipients during February–August 2020: A systematic review

Cited by 12 publications

References 58 publications

Incidence, Risk Factors, and Outcomes of COVID-19 Infection in a Large Cohort of Solid Organ Transplant Recipients

Incidence, Risk Factors, and Outcomes of COVID-19 Infection in a Large Cohort of Solid Organ Transplant Recipients

Immune Response to COVID-19 and mRNA Vaccination in Immunocompromised Individuals: A Narrative Review

Immune Response to SARS-CoV-2 Vaccine among Heart Transplant Recipients: A Systematic Review

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