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Challenges in heart transplantation during COVID-19: A single-center experience
Aditi Singhvi1, Maya Barghash1, Anuradha Lala2
1Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
Insights
Orthotopic heart transplant (OHT) recipients with COVID-19 had outcomes similar to the general population. Performing OHT during the pandemic is feasible with precautions, but further research on immunosuppression is needed.
Area of Science:
- Cardiology
- Infectious Diseases
- Transplantation Immunology
Background:
- Orthotopic heart transplantation (OHT) recipients are potentially vulnerable to COVID-19.
- The COVID-19 pandemic presents unique challenges for OHT feasibility and safety.
Purpose of the Study:
- To evaluate the outcomes of OHT recipients who contracted COVID-19.
- To assess the safety and feasibility of performing OHT during the COVID-19 pandemic.
Main Methods:
- Retrospective chart review of OHT recipients with COVID-19 and those undergoing OHT during the pandemic (March 1, 2020, to May 15, 2020).
Main Results:
- Of 22 OHT recipients with COVID-19, 23% experienced severe or critical illness, and 23% expired. Outcomes were similar to the general hospitalized COVID-19 population.
- Five patients underwent OHT during the pandemic; all survived and were discharged without complications.
- One OHT recipient contracted mild COVID-19 post-transplant.
Conclusions:
- OHT recipients with COVID-19 may have similar outcomes to the general population.
- OHT is feasible during the pandemic with appropriate safety measures.
- Further research is required to optimize immunosuppression strategies for OHT recipients with COVID-19.
Background:
Orthotopic heart transplantation (OHT) recipients may be particularly vulnerable to coronavirus disease 2019 (COVID-19). OHT during the pandemic presents unique challenges in terms of feasibility and safety.
Methods:
Chart review was performed for consecutive OHT recipients with COVID-19 and waitlisted patients who underwent OHT from March 1, 2020 to May 15, 2020.
Results:
Of the approximately 400 OHT recipients followed at our institution, 22 acquired COVID-19. Clinical characteristics included median age 59 (range, 49-71) years, 14 (63.6%) were male, and median time from OHT to infection was 4.6 (2.5-20.6) years. Symptoms included fever (68.2%), gastrointestinal complaints (55%), and cough (46%). COVID-19 was severe or critical in 5 (23%). All patients had elevated inflammatory biomarkers. Immunosuppression was modified in 85% of patients. Most (n = 16, 86.4%) were hospitalized, 18% required intubation, and 14% required vasopressor support. Five patients (23%) expired. None of the patients requiring intubation survived. Five patients underwent OHT during the pandemic. They were all males, ranging from 30 to 59 years of age. Two were transplanted at United Network of Organ Sharing Status 1 or 2, 1 at Status 3, and 2 at Status 4. All were successfully discharged and are alive without allograft dysfunction or rejection. One contracted mild COVID-19 after the index hospitalization.
Conclusion:
OHT recipients with COVID-19 appear to have outcomes similar to the general population hospitalized with COVID-19. OHT during the pandemic is feasible when appropriate precautions are taken. Further study is needed to guide immunosuppression management in OHT recipients affected by COVID-19.
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