Four Years of Clinical Experience With COVID-19 Outcomes in Heart Transplant Recipients

BACKGROUND COVID-19 significantly impacted the outcomes of patients, particularly those with comorbidities, including solid organ transplant recipients. The aim of this study was to investigate the incidence and mortality of COVID-19, as well as to identify independent risk factors associated with COVID-19-related death in patients undergoing orthotopic heart transplantation (OHT). MATERIAL AND METHODS The study followed 556 heart transplant recipients at a high-volume transplant center in Poland from March 2020 to March 2024. Patients were classified as infected based on a positive result from reverse transcription-polymerase chain reaction (RT-PCR) tests or SARS-CoV-2 antigen rapid tests performed on nasopharyngeal swab samples. RESULTS In the analyzed cohort, 189 of 556 patients (33.99%; 40 women, 21.16%) were diagnosed with COVID-19 following OHT. In total, 15 patients (7.94%) experienced recurrent SARS-CoV-2 infections, with 1 patient being diagnosed 3 times. A total of 33 patients (5.94%) required hospitalization due to COVID-19. Among the entire study cohort, 75 patients (13.49%) died, with 18 of these deaths (24%) directly attributable to COVID-19. In the multivariable analysis, vaccination against COVID-19 was identified as a protective factor against death due to the virus (OR, 0.22; 95% CI, 0.07-0.68; P=0.009) while increasing age was associated with a higher risk of mortality (OR, 1.08; 95% CI, 1.02-1.14; P=0.008). CONCLUSIONS The lack of COVID-19 vaccination and advanced age significantly influenced the COVID-19-related mortality risk.