(578) Severe Covid-19 Infection Causing Severe Vasculopathy Resulting in Death in a Heart Transplant Recipient

INTRODUCTION: Due to chronic immunosuppression and frequent comorbidities, severe infection with Covid-19 is common among heart transplant recipients. Heart transplant recipients with Covid-19 have a short-term mortality rate as high as 25% and hospitalization rates as high as 77%. These patients generally have a severe course of infection and present with right ventricular dysfunction, arrhythmias, and thromboembolic events. We present the case of a heart transplant recipient who presented with Covid-19 infection who, despite initial improvement, eventually passed from severe coronary vasculopathy. The incidence of vasculopathy six months post-transplant without coexisting infection is extremely uncommon. CASE REPORT: A 45-year-old male with end stage heart failure due to non ischemic cardiomyopathy underwent heart transplant in July 2021. Post-transplant, the patient was clinically stable with LVEF of 60-65%. In January 2022, the patient was admitted for cardiogenic shock with multi-organ failure and tested positive for Covid-19. His echo showed an LVEF of 20-25%. Inotrope therapy was initiated and an intra-aortic balloon pump was placed. Hemodialysis was begun due to oliguria and acute renal failure. RV biopsy indicated moderate acute T-cell mediated rejection and was treated appropriately. Prior to discharge following his six week hospitalization, pathology was negative for rejection and his LVEF increased to 50%. 3 weeks later, he was found unresponsive at home and pronounced dead by EMS. Autopsy determined that the cause of death was sudden cardiac death due to Covid-19. Autopsy Report: "The cause of death is sudden cardiac death secondary to a rapidly progressive graft vasculopathy with concomitant endothelitis and positive staining of endothelium for SARS-CoV-2 viral nucleoprotein, with consequent diffuse myocardial necrosis.” The kidneys were enlarged with findings indicating Acute Tubular Necrosis. SUMMARY: Our patient presented six months post-transplant with severe Covid-19 induced coronary vasculopathy which progressed to sudden cardiac death. This case demonstrates the importance of preventing Covid-19 infection among heart transplant recipients and the need to assess these patients for coronary vasculopathy prior to progression to sudden cardiac death.