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Characteristics and outcomes of COVID-19 in heart transplantation recipients in the Netherlands
S A Muller1, O C Manintveld2,3, M K Szymanski1
1Department of Cardiology, Division Heart and Lung, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
Insights
Heart transplant recipients with COVID-19 faced higher hospitalization risks, but their overall mortality was lower than expected. This study highlights outcomes for immunocompromised patients after heart transplantation during the pandemic.
Area of Science:
- Cardiology
- Infectious Diseases
- Immunology
Background:
- Immunocompromised individuals, including heart transplant (HTx) recipients, are susceptible to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
- Understanding coronavirus disease 2019 (COVID-19) outcomes in HTx patients is crucial for managing this high-risk population.
Purpose of the Study:
- To describe the characteristics and outcomes of heart transplantation recipients diagnosed with COVID-19 in the Netherlands.
- To assess the mortality and disease severity in this specific patient group.
Main Methods:
- Retrospective study including HTx patients with confirmed COVID-19 (PCR or serology) between February 2020 and June 2021.
- Primary endpoint: all-cause mortality. Secondary endpoint: disease severity (hospitalization, ICU admission, death).
Main Results:
- COVID-19 was diagnosed in 8% (54/665) of HTx patients, a mean of 11 years post-transplant.
- 39% required hospitalization, and 13% experienced severe COVID-19 (ICU admission or death). In-hospital mortality was 14%, with an overall 6% all-cause mortality.
- Severe COVID-19 was associated with earlier transplantation and higher BMI compared to moderate cases.
Conclusions:
- Heart transplant recipients are at increased risk for complicated COVID-19, necessitating frequent hospitalizations.
- However, the observed all-cause mortality (6%) was significantly lower than previously reported ranges (7-33%) for this population.
Background:
Immunocompromised patients are at high risk of complicated severe acute respiratory coronavirus 2 infection. The aim of this retrospective study was to describe the characteristics and outcomes of heart transplantation (HTx) recipients with coronavirus disease 2019 (COVID-19) in the Netherlands.
Methods:
HTx patients from one of the three HTx centres in the Netherlands with COVID-19 (proven by positive reverse-transcription polymerase chain reaction or serology test result) between February 2020 and June 2021 were included. The primary endpoint was all-cause mortality and the secondary endpoint was disease severity.
Results:
COVID-19 was diagnosed in 54/665 HTx patients (8%), with a mean (± standard deviation (SD)) time after HTx of 11 ± 8 years. Mean (± SD) age was 53 ± 14 years and 39% were female. Immunosuppressive therapy dosage was reduced in 37% patients (20/54). Hospitalisation was required in 39% patients (21/54), and 13% patients (7/54) had severe COVID-19 (leading to intensive care unit (ICU) admission or death). In-hospital mortality was 14% (3/21), and all-cause mortality was 6%. Compared with patients with moderate COVID-19 (hospitalised without ICU indication), severe COVID-19 patients tended to be transplanted earlier and had a significantly higher mean (± SD) body mass index (26 ± 3 vs 30 ± 3 kg/m2, p = 0.01). Myocardial infarction, cellular rejection and pulmonary embolism were observed once in three different HTx patients.
Conclusion:
HTx patients were at increased risk of complicated COVID-19 with frequent hospitalisation, but the all-cause mortality was substantially lower than previously described (7-33%).
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