Impact of COVID19 Infection Among Heart Transplanted Recipients: The Experience of a Latin American Center

PURPOSE: Heart transplanted recipients are at a high risk for COVID19 infection. Clinical presentation, complications, and related outcomes have been described worldwide. However, there is a paucity of data in Latin America. METHODS: Retrospective cohort of heart transplanted recipients followed at a center in Rio Grande do Sul, Brazil, between March 1st 2020 to October 1st 2021. Data are presented as absolute numbers (percentage) or median (interquartile). RESULTS: Among 62 recipients in follow-up, 21 (34%) were infected by COVID19. 58 (36-63) years, 67% male, body mass index of 26 kg/m², 48% with hypertension, 43% with chronic kidney disease, 5% diabetes, 3.1 (1.0-4.2) years post-transplant. Most common symptoms at presentation were fever (62%), myalgia (33%), cough (33%), and headache (33%). Dyspnea occurred in only 19% patients. Hospitalization was required for 13 (62%) with a time from symptoms onset to admission of 5 (1-12) days. In 38%, supplementary oxygen was needed, 19% required intensive care, and 10% mechanical ventilation. Main complications were bacterial pneumonia (38%), renal replacement therapy (19%), sepsis (10%), venous thromboembolism (10%), and pancreatitis (5%). Immunosuppression therapy was modified in 48% (in majority 89%, reduced). Median hospitalization time was 17 (8-28) days. Two (10%) patients died in hospital due to refractory hypoxemia and multiorgan dysfunction. The prevalence of COVID19 among heart transplanted patients was comparable to the general population in the state of Rio Grande do Sul (Figure 1) with a peak in December 2020. CONCLUSION: COVID19 infection prevalence among heart transplanted recipients was elevated, presenting mostly with typical symptoms, and frequent hospitalizations, supplementary oxygen requirement, and complications. Although the COVID19 prevalence in Latin America was amongst the highest reported, in-hospital mortality among infected heart transplanted recipients was similar to previously published data worldwide.