(590) Sars_Cov2 Experience in the West Australian Heart Transplant Population

PURPOSE: To describe the COVID-19 experience among the heart transplant recipient cohort at the West Australian Advanced Heart Failure Cardiac Transplant Unit. METHODS: Retrospective observational cohort study between January 2020 and October 2022. Primary outcome measures reviewed in digital medical records included hospital admission numbers, disease severity, prevalence of COVID-19 deterioration risk factors, immunisation status, severity of infection, graft function, immunosuppression and treatment regime. RESULTS: The unit supports 152 heart transplant recipients. A total of 35 patients, (23.0%) contracted COVID-19 during the study period. Infection all occurred during the local Omicron wave from February 2022. The cohort had a median age of 55 years (IQR 49-63.5) with a male gender predominance (74.3%). Most patients were classified as mild COVID-19 (n=32, 91.4%) and 74.3% of the cohort were managed in the community with remote monitoring of clinical status. COVID-19 vaccination status at the time of infection up-to-date according to national guidelines for 80.0% of the transplant patients. Only one patient was unvaccinated. Antiviral treatment was predominantly with Molnupiravir (74.3%) with 22.9% of COVID-19 positive heart transplant patients receiving pre-exposure prophylaxis with Evusheld. Of the cohort admitted to hospital (n=9) the mode of oxygen therapy was dominated by nasal cannula (n=4)) followed by non-invasive ventilation (n=1). The median length of stay for the admitted cohort was 4 days (IQR 3-8.5). Four patients had repeat hospital admissions due to COVID-19 throughout the study period. Most patients had stable graft function demonstrated as stable left ventricular ejection fraction on trans-thoracic echocardiogram within six months of COVID-19. 18 patients had monitoring of donor-specific antibody profiling post COVID-19 which demonstrate no antibody increase. CONCLUSION: COVID-19 in heart transplant recipients in WA was predominately of mild severity, due to infection occurring in a highly vaccinated population with a milder variant.