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

Area of Science:

• Cardiology
• Infectious Diseases
• Transplantation Immunology

Background:

• The effects of COVID-19 on heart transplant (HTx) recipients are not well understood, especially in the early post-transplant phase.
• This study examines five HTx patients diagnosed with COVID-19 at an institution during the pandemic's peak.

Purpose of the Study:

• To investigate the clinical presentation and outcomes of heart transplant recipients with COVID-19.
• To understand the impact of COVID-19 on immunosuppressed patients in the early post-transplant period.

Main Methods:

• Case series of five heart transplant recipients with COVID-19.
• Analysis of clinical data, including illness severity, immunosuppressive regimens (mycophenolate mofetil, tacrolimus, prednisone), laboratory markers (lymphopenia, C-reactive protein, procalcitonin, ferritin), and chest imaging.
• Management strategies included mycophenolate mofetil discontinuation and convalescent plasma for severe cases.
• Endomyocardial biopsies were performed on recent transplant recipients.

Main Results:

• All five patients presented with moderate (n=3) or severe (n=2) COVID-19 illness.
• Severe cases occurred in patients transplanted ~6 weeks prior and showed profound lymphopenia and elevated inflammatory markers.
• All patients had bilateral ground-glass opacities on chest imaging.
• No acute cellular rejection or viral particles were found in endomyocardial biopsies of recent transplants.
• Two severe cases improved but remained hospitalized; three moderate cases were discharged within 30 days.

Conclusions:

• COVID-19 infection poses a significant risk to heart transplant recipients, particularly in the early post-transplant period.
• Early immunosuppression and viral infection may exacerbate disease severity and impact outcomes in this vulnerable population.