(420) Covid-19 after Heart Transplantation: Treatment and Outcome in a German Transplant Centre

PURPOSE: The pandemic caused by SARS-CoV-2 is resulting in hospitalizations and increased mortality worldwide. Given the potentially high prevalence and severity of COVID-19 in heart transplant recipients, there is a great need for data in this high-risk cohort. Here, we report our experience with the outcomes and management of heart transplant recipients infected with SARS-CoV-2 at a German transplant center across recent pandemic waves. METHODS: All adult patients who had received heart transplantation at our center and who were confirmed to have COVID-19 infection between 12/2020 and 07/2022 (n = 48) were included and retrospectively characterized. RESULTS: The mean age was 60.5 (46.3-63.8) years, and the majority were male (83%). The hospitalization rate was 83%, while comorbidities included diabetes (31%), arterial hypertension (73%) and chronic renal failure (90%). 90% of all SARS-CoV-2-positive HTx patients were infected since the start of our vaccination campaign (03/2021), while of those 43 patients, 88% were fully vaccinated at the time of infection (vaccine breakthrough). The median time from vaccination to infection in these patients was 138 (85-225) days. Antiviral therapy was administered in 83% of all cases, and passive immunization (convalescent plasma/monoclonal antibodies) was given in 98% of all cases. Oxygen administration was required in 10% of patients; only one patient required noninvasive ventilation (2%), and no patient required invasive ventilation or mechanical cardiovascular support (ECMO). No new cardiovascular or thromboembolic events were noted, and we observed no COVID-19-associated mortality. CONCLUSION: With increasing number of vaccinated patients and treatment options, we did not detect severe courses or increased mortality of COVID-19 in heart transplant recipients. Prospective studies are needed to provide better prognostic assessments of COVID-19 in (heart) transplanted patients in the future.