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COVID-19 in heart transplant recipients during February-August 2020: A systematic review
Carlos Diaz-Arocutipa1,2,3, Darla Carvallo-Castañeda3,4, Odalis Luis-Ybañez3,5
1Vicerrectorado de Investigación, Universidad San Ignacio de Loyola, Lima, Peru.
Insights
Heart transplant recipients with COVID-19 showed similar symptoms to the general population but faced a poor prognosis. This review highlights the critical need for careful management of these immunocompromised patients during the pandemic.
Area of Science:
- Cardiology
- Infectious Diseases
- Transplantation Medicine
Background:
- The COVID-19 pandemic poses significant risks to immunosuppressed individuals, particularly heart transplant recipients.
- Understanding the impact of SARS-CoV-2 infection in this vulnerable population is crucial for clinical management.
Purpose of the Study:
- To systematically review and summarize the clinical characteristics, treatment strategies, and outcomes of heart transplant recipients diagnosed with COVID-19.
Main Methods:
- A systematic literature search was conducted across electronic databases up to January 11, 2021.
- Data from 39 articles, including 22 case reports and 17 cohort studies encompassing 415 patients, were analyzed.
Main Results:
- The study population had a mean age of 59.9 years, with 77% being male. Common symptoms included fever (70%) and cough (67%).
- 48% of patients experienced severe or critical COVID-19. Common treatments involved hydroxychloroquine (54%), azithromycin (14%), and lopinavir/ritonavir (14%).
- Mortality rates were high, with 25% short-term mortality reported in inpatient cohorts. Immunosuppressive regimens were modified, with antimetabolite discontinuation in 49% of patients.
Conclusions:
- Heart transplant recipients with COVID-19 present with demographic and clinical features comparable to the general population.
- Despite similar initial presentations, these patients experience a significantly poorer prognosis, underscoring the severity of COVID-19 in this immunosuppressed group.
Abstract:
The coronavirus disease 2019 (COVID-19) pandemic represents a major concern in immunosuppressed patients such as heart transplant recipients. Therefore, we performed a systematic review to summarize the clinical features, treatment, and outcomes of heart transplant recipients with COVID-19. We searched electronic databases from inception to January 11, 2021. Thirty-nine articles (22 case reports and 17 cohorts) involving 415 patients were included. The mean age was 59.9 ± 15.7 years and 77% of patients were men. In cohort studies including outpatients and inpatients, the hospitalization rate was 77%. The most common symptoms were fever (70%) and cough (67%). Inflammatory biomarkers (C-reactive protein and procalcitonin) were above the normal range. Forty-eight percent of patients presented with severe or critical COVID-19. Hydroxychloroquine (54%), azithromycin (14%), and lopinavir/ritonavir (14%) were the most commonly used drugs. Forty-nine percent of patients discontinued the baseline regimen of antimetabolites. In contrast, 59% and 73% continued the same regimen of calcineurin inhibitors and corticosteroids, respectively. Short-term mortality among cohorts limited to inpatients was 25%. Our review suggests that heart transplant recipients with COVID-19 exhibited similar demographic and clinical features to the general population. However, the prognosis was poor in these patients.
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