Severity of SARS-CoV-2 Omicron variant infection in heart transplant recipients

Hazan, Fanny; Verdonk, Constance; Coutance, Guillaume; Ferré, Valentine Marie; Marot, Stéphane; Melo, Vania Da Dilva; Legeai, Camille; Lebreton, Guillaume; Para, Marylou; Varnous, Shaïda; Dorent, Richard

doi:10.1016/j.healun.2023.01.012

Cited by 7 publications

(10 citation statements)

References 9 publications

(15 reference statements)

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“…This suggests that the added value of pre-procedural SARS-CoV-2 testing in asymptomatic patients admitted to the hospital for a potential heart transplantation procedure is questionable. This is further illustrated by the reduced fatality rates with the new SARS-CoV-2 variants in both the transplant and general population [ 11 , 12 , 13 , 14 ], the relatively low prevalence of COVID-19 in the Netherlands and similarities with other (more common) nosocomial viral infections for which routinely pre-operative testing is not recommended in the absence of symptoms [ 5 ]. Of note, if future variants of SARS-CoV-2 turn out to be more lethal or contagious despite current measures, this could obviously warrant reinitiation of stricter testing protocols.…”

Section: Discussionmentioning

confidence: 99%

“…In recipients of solid organ transplantations, a recent study has shown that the risk of hospitalization (incidence rate ratio of 0.45) and death (incidence rate ratio of 0.17) after SARS-CoV-2 infection decreased significantly with the Omicron variants compared to pre-Omicron variants [ 13 ]. Interestingly, a recent study in a cohort of French HTx recipients suggests that the absolute numbers for mortality only slightly decreased during Omicron compared to Delta variants for HTx recipients (9.6% versus 16.1% mortality rates), but not as much as in the general population [ 14 ]. The relative mortality compared to the general population for HTx recipients was high in Omicron HTx recipients with an incidence of 289 per 100,000 for HTx (compared to 3.2 per 100,000 in the general population, respectively) [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

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Pre-Operative SARS-CoV-2 Testing in Asymptomatic Heart Transplantation Recipients

et al. 2023

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Introduction: From the start of the coronavirus disease 2019 (COVID-19) pandemic, international guidelines have recommended pre-operative screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) before heart transplantation (HTx). Due to the changing prevalence of COVID-19, the chances of false positive results have increased. Because of increased immunity in the population and evolution of SARS-CoV-2 to current Omicron variants, associated mortality and morbidity have decreased. We set out to investigate the yield and side effects of SARS-CoV-2 screening in our center. Methods: We performed a retrospective cohort study in the University Medical Center Utrecht. The study period was from March 2019 to January 2023. All data from patients who underwent HTx were collected, including all pre-operative and post-operative SARS-CoV-2 tests. Furthermore, all clinical SARS-CoV-2 tests for the indication of potential HTx were screened. Results: In the period under study, 51 patients underwent HTx. None of the recipients reported any symptoms of a viral infection. Fifty HTx recipients were screened for SARS-CoV-2. Forty-nine out of fifty patients tested negative. One patient had a false positive result, potentially delaying the HTx procedure. There were no cancelled HTx procedures due to a true positive SARS-CoV-2 test result. Conclusion: Pre-operative SARS-CoV-2 screening in asymptomatic HTx recipients did not lead to any true positive cases. In 2% of the cases, screening resulted in a false positive test result. With the current Omicron variants, in combination with a low-prevalence situation, we propose to abandon pre-operative SARS-CoV-2 screening and initiate a symptom-driven approach for the general viral testing of patients who are called in for a potential HTx.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pre-Operative SARS-CoV-2 Testing in Asymptomatic Heart Transplantation Recipients

et al. 2023

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“…Ongoing unacceptably high rates of breakthrough infections and mortality in this patient population are still being reported. 1 Optimization of vaccination strategies requires an understanding of how immune responses are affected by repeat immunogenic stimulations elicited by standard vaccine regimens, boosted regimens, or by the combination of vaccination and natural infection. 2 Although much has been learned about the response to COVID19 vaccines in SOT recipients, the magnitude, quality, and durability of serological responses and the likelihood of neutralizing protection against future SARS-CoV-2 variants following these modes of exposure are unknown but are critical to the future trajectory of the COVID-19 pandemic and to vaccination strategies.…”

Section: Neutralization Of Sars-cov-2 Variants Elicited By the Combin...mentioning

confidence: 99%

Neutralization of SARS‐CoV‐2 variants elicited by the combination of vaccination and natural infection in heart transplant recipients

Peled

Afek

Patel³

et al. 2023

Clinical Transplantation

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“…The consequences of this combination for HT recipients are more severe COVID-19 and a greater risk of mortality. 7,8 Realizing from the outset that the COVID-19 pandemic would have a particularly adverse impact on immunocompromised individuals, we proactively promoted the vaccination of our HT patients.…”

Section: Introductionmentioning

confidence: 99%

“…For HT patients, these challenges are compounded by coexisting medical comorbidities, increased exposure to SARS‐CoV‐2 (given their frequent contact with the health‐care system), reduced immune responses following vaccination and, paradoxically, exclusion from clinical trials (calling into question the effectiveness of vaccination). The consequences of this combination for HT recipients are more severe COVID‐19 and a greater risk of mortality 7,8 …”

Section: Introductionmentioning

confidence: 99%

BNT162b2‐vaccine‐induced neutralization responses are immune correlates of clinical protection against SARS‐CoV‐2 in heart transplant recipients

Peled,

Patel,

Raanani

et al. 2023

Clinical Transplantation

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BackgroundDefining immune correlates of protection against COVID‐19 is pivotal for optimizing the use of COVID‐19 vaccines, predicting the impact of novel variants on clinical outcomes, and advancing the development of immunotherapies and next‐generation vaccines. We aimed to identify vaccine‐induced immune correlates of protection against COVID‐19‐related hospitalizations in a highly vaccinated heart transplant (HT) cohort.MethodsIn a case‐control study of HT recipients vaccinated with the BNT162b2 vaccine, patients were prospectively assessed for vaccine‐induced neutralization of the wild‐type virus, and the Delta and Omicron BA.1, BA.2, BA.4, and BA.5 variants. Comparative analyses with controls were conducted to identify correlates of protection against COVID‐19 hospitalization. ROC analyses were performed. Primary outcomes were COVID‐19 hospitalizations and severity of SARS‐CoV‐2 breakthrough infection.ResultsThe study cohort comprised 59 HT recipients aged 58 (49,65) years with breakthrough infections after three or four monovalent BNT162b2 doses; 41 (69.5%) were men. Thirty‐six (61%) patients with COVID‐19 were hospitalized; most cases were non‐severe (58, 98%). For hospitalized (vs. non‐hospitalized) COVID‐19 patients, vaccine‐induced neutralization titers were significantly lower against all SARS‐CoV‐2 variants (p < .005). Vaccine‐induced neutralization of the wild‐type virus and delta and omicron BA.1, BA.2, BA.4, and BA.5 variants was associated with a reduced risk for COVID‐19‐related hospitalization. The optimal neutralization titer thresholds that were predictive of COVID‐19 hospitalizations were 96 (wild‐type), 48 (delta), 12 (BA.1), 96 (BA.2), 96 (BA.4), and 48 (BA.5).ConclusionsBNT162b2‐vaccine‐induced neutralization responses are immune correlates of protection and confer clinical protection against COVID‐19 hospitalizations.

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Severity of SARS-CoV-2 Omicron variant infection in heart transplant recipients

Cited by 7 publications

References 9 publications

Pre-Operative SARS-CoV-2 Testing in Asymptomatic Heart Transplantation Recipients

Pre-Operative SARS-CoV-2 Testing in Asymptomatic Heart Transplantation Recipients

Neutralization of SARS‐CoV‐2 variants elicited by the combination of vaccination and natural infection in heart transplant recipients

BNT162b2‐vaccine‐induced neutralization responses are immune correlates of clinical protection against SARS‐CoV‐2 in heart transplant recipients

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