Characteristics and Outcomes of Heart Transplant Recipients with Coronavirus-19 Disease

PURPOSE: Heart transplant(HT) recipients with SARS-CoV-2 infection may be at high risk of developing critical illness. The aim was to describe the characteristics and clinical outcomes of HT recipients with coronavirus-19 disease(COVID-19). METHODS: We prospectively included all adult HT recipients who received the diagnosis of COVID-19 in our institution. Inclusion criteria were one or more clinical symptoms of SARS-CoV-2 infection in the previous seven days and positive SARS-CoV-2 RT-PCR in nasopharyngeal samples. The enrollment was carried out from April to June, 2020. Demographic features, clinical characteristics, modes of transmission, laboratory data and other known prognosis markers at admission and through follow up were recorded. Patients were categorized according to the ordinal scale developed by WHO Committee. Outcomes and follow up were recorded until Aug/2020. RESULTS: Twenty-one HT recipients were included, most of them were men (57%); with median age of 48 years old and median HT time of 12 mo. The majority needed hospitalization. Immunosuppressive therapy was reduced or withdrawn in the majority of patients, except from steroids. Ten patients were classified as having severe disease according to WHO Committee scale. Lymphopenia was an independent predictor of severe disease and absolute lymphocyte count <416/mm(3) had 82% of sensitivity and 90% of specificity to define severe disease. Thirty-day mortality was 14%, similar to previously reported in other solid-organ transplant (SOT) cohorts. However, a longer follow up revealed increased 60-day mortality (33%) due to nosocomial infection. CONCLUSION: In this case series of HT recipients with COVID-19, the 30-day mortality rate was similar to that previously reported in SOT recipient's cohorts, but a longer follow up revealed increased later mortality related to long in-hospital stay. Further, lymphopenia was associated with severe disease and worse prognosis. These findings suggest the need for strict long-term follow up of these patients.