COVID‐19 in recent heart transplant recipients: Clinicopathologic features and early outcomes

Abstract

Background: The impact of COVID-19 on heart transplant (HTx) recipients remains unclear, particularly in the early post-transplant period. Methods: We share novel insights from our experience in five HTx patients with COVID-19 (three within 2 months post-transplant) from our institution at the epicenter of the pandemic. Results: All five exhibited moderate (requiring hospitalization, n = 3) or severe (requiring ICU and/or mechanical ventilation, n = 2) illness. Both cases with severe illness were transplanted approximately 6 weeks before presentation and acquired COVID-19 through community spread. All five patients were on immunosuppressive therapy with mycophenolate mofetil (MMF) and tacrolimus, and three that were transplanted within the prior 2 months were additionally on prednisone. The two cases with severe illness had profound lymphopenia with markedly elevated C-reactive protein, procalcitonin, and ferritin. All had bilateral ground-glass opacities on chest imaging. MMF was discontinued in all five, and both severe cases received convalescent plasma. All three recent transplants underwent routine endomyocardial biopsies, revealing mild (n = 1) or no acute cellular rejection (n = 2), and no visible viral particles on electron microscopy. Within 30 days of admission, the two cases with severe illness remain hospitalized but have clinically improved, while the other three have been discharged.

COVID-19 in immunocompromised patients: A systematic review of cancer, hematopoietic cell and solid organ transplant patients

“…Of these, nine SOT 31 , 42 , 44 , 45 , 49 , 67 , 73 , 76 , 134 studies and one A-CA study 135 reported median CRP values above the 95% confidence interval for the general population. 128 Of 18 SOT studies and one A-CA study reporting ferritin levels, only one SOT study 63 reported a median ferritin level in the normal range with the remainder of studies having elevated values (Supplemental Figure 2B). All but one 31 of the SOT studies reporting LDH data (n=16) had median values above the normal range (Supplemental Figure 2C).…”

“…To be included, the study must have reported clinical data on adult (A-CA) or pediatric (P-CA) cancer patients and SOT or HCT recipients with confirmed COVID-19. Our inclusion and exclusion criteria identified 64 SOT studies, 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 11 HCT studies,…”

SARS-CoV-2 (COVID-19) in patients with some degree of immunosuppression

“…There are recommendations about discontinuing mycophenolate in critically ill transplant recipients, 98 which would also apply to COVID-19, bearing in mind that during the H1N1 pandemic it was documented that this drug decreased the serological response in transplant recipients. 97 However, given the scarcity of data, this decision must be tailored to each patient in this special subgroup.…”

COVID-19 neutralizing antibody-based therapies in humoral immune deficiencies: A narrative review

“…Only a paucity of data has been published on the clinical course of COVID-19 in recipients of solid organ and hematopoietic stem cell transplants [ [45] , [46] , [47] ]. Even fewer data are available on the possible treatments for viral infection is such immunocompromised patients, including the CP use [ [48] , [49] , [50] , [51] , [52] , [53] , [54] ].…”