(662) Heart and Lung Transplant Unit - Western Australia Covid-19 Experience

PURPOSE: To describe the COVID-19 experience among the highly immunosuppressed heart and lung transplant patient cohort at the West Australian Heart and Lung Transplant Unit. METHODS: Retrospective observational cohort study between January 2020 and October 2022 at the states only quaternary hospital. RESULTS: The WA state heart-lung transplant service supports 297 recipients, 152 under the advanced heart failure unit and 145 patients under the care of the advanced lung disease unit. WA was in a unique position with COVID-19 secondary to border closures, high vaccination rates and community transmission with the Omicron wave. A total of 74 patients (24.9%) across the WA unit contracted COVID-19 during the study period. The median age was 53 years (IQR 42-60) with a male gender predominance (63.5%). The heart transplant cohort had a 23.0% (n=35) COVID-19 infection prevalence. The lung transplant cohort had 31.0% (n=45) COVID-19 positive patients across the study period. Bilateral sequential lung transplants BLST (n=38, 84.4%) was the most common transplant type, followed by heart-lung transplant (n=5, 11.1%) and then single lung transplant (n=2, 4.5%). Most patients across both units were classified as mild COVID-19, with only a small proportion of patients requiring hospitalisation (n=24, 32.4%). Cough (60.0%) and sore throat (55.6%) were the most common initial symptoms reported by the patients. COVID-19 vaccination status at the time of infection was higher than 80%. Pre-exposure prophylaxis was given to 35% of the patients who had COVID-19 infection. Most patients had stable graft function despite COVID-19 as measured by left ventricular ejection fraction on trans-thoracic echocardiogram or forced expiratory volume. CONCLUSION: Overall the WA COVID-19 case numbers and disease severity in the highly immunocompromised transplant cohort were minimal. Disease severity, morbidity and mortality were low when compared to the predicted modelling for this at-risk cohort released by the Department of Health.