Outcomes of COVID-19 in Heart Transplant Recipients

PURPOSE: Data on outcomes after Covid-19 in heart transplant recipients are scarce and inconsistent. We sought to evaluate the early and late post-discharge outcomes in this patient population. METHODS: This case series includes 19 consecutive adult heart transplant recipients hospitalized for Covid-19 at our tertiary center between March 1, 2020 and April 30, 2021. After discharge, all patients were followed per standard post-transplant protocol for 6 months. Significant allograft dysfunction was defined as a decrease in LVEF ≥ 10% and myocardial damage was defined as at least 30% increase in troponin or NT-proBNP serum levels. CMV reactivation was defined as any positive PCR CMV requiring virostatic therapy. RESULTS: Of 19 recipients 15 (79%) were male with a mean age of 62±8 years and a mean time from transplantation of 4.5±3.4 years. 14 (73%) and 5 (26%) recipients had hypertension and diabetes, respectively. Immunosupressive (IS) regimen at the time of infection consisted of tacrolimus (TAC; mean C0 level 7.5±2.1 μg/mL), mycophenolate mofetil (MMF; mean dose 2052±359 mg) and steroids (mean dose 4.6±4.7 mg). During hospital management IS was reduced in 6 (31%) patients with a maintenence of TAC serum levels (mean C0 7.7±1.9 μg/mL pre-infection vs. 7.5±2.2 μg/mL during infection, P=0.75) and a decrease of MMF dose (2052±359 mg vs. 1906±657 mg, P= 0.01). In 11 (58%) patients we applied oxygen supplementation; however none required non-invasive or invasive forms of ventilation. During hospitalisation 12 (63%) recipients received hyperimmune plasma, 13 (68%) were treated with remdesivir (cumulative dose 600 mg), and 11 (58%) received steroid therapy (mean methylprednisolone dose 29±21 mg). All recipients survived to discharge (mean hospitalization time of 17.4±12.6 days) and to 6-month follow-up. We found no evidence of allograft dysfunction (LVEF 67±6% at baseline vs 68±7% at follow-up; P=0.88) or persistent myocardial damage (troponin: 22±28 pg/mL vs. 14±21 pg/mL; P=0.41 and NT-proBNP: 829±823 pg/mL vs. 817±940 pg/mL; P=0.96). CMV reactivation occured in 3 (16%) recipients and in 1 (5%) recipient a thrombotic event was noted. CONCLUSION: Covid-19 outcomes in heart transplant recipients appear to be acceptable when managed in a tertiary center with dedicated heart transplant and Covid-19 facilities. Further data is needed to establish optimal Covid-19 management algorithms for this patient population.