Challenges in heart transplantation during COVID-19: A single-center experience

JOURNAL OF HEART AND LUNG TRANSPLANTATION

卷:39

Article

Singhvi, Aditi¹  Barghash, Maya¹  Lala-Trindade, Anuradha^1,2  Mitter, Sumeet S.¹  Parikh, Aditya¹  Oliveros, Estefania¹  Rollins, Brett M.³  Brunjes, Danielle L.¹  Alvarez-Garcia, Jesus¹  Johnston, Erika¹  Ryan, Kieran¹  Itagaki, Shinobu⁴  Moss, Noah¹  Pinney, Sean P.¹  Anyanwu, Anelechi⁴  Mancini, Donna^1,2 

[1] Icahn Sch Med Mt Sinai, Zena & Michael A Wiener Cardiovasc Inst, New York, NY 10129 USA

[2] Icahn Sch Med Mt Sinai, Dept Populat Hlth Sci & Policy, New York, NY 10129 USA

[3] Mt Sinai Hosp, Dept Pharm, New York, NY USA

[4] Mt Sinai Med Ctr, Dept Cardiovasc Surg, New York, NY USA

关键词: COVID-19;    heart transplant;    immunosuppression;    inflammatory biomarkers;    outcomes;   

DOI  :  10.1016/j.healun.2020.06.015

来源: Elsevier

【 摘 要 】

BACKGROUND: Orthotopic heart transplantation (OHT) recipients may be particularly vulnerable to coronavirus disease 2019 (COVID-19). OHT during the pandemic presents unique challenges in terms of feasibility and safety. METHODS: Chart review was performed for consecutive OHT recipients with COVID-19 and waitlisted patients who underwent OHT from March 1, 2020 to May 15, 2020. RESULTS: Of the approximately 400 OHT recipients followed at our institution, 22 acquired COVID-19. Clinical characteristics included median age 59 (range, 49-71) years, 14 (63.6%) were male, and median time from OHT to infection was 4.6 (2.5-20.6) years. Symptoms included fever (68.2%), gastrointestinal complaints (55%), and cough (46%). COVID-19 was severe or critical in 5 (23%). All patients had elevated inflammatory biomarkers. Immunosuppression was modified in 85% of patients. Most (n = 16, 86.4%) were hospitalized, 18% required intubation, and 14% required vasopressor support. Five patients (23%) expired. None of the patients requiring intubation survived. Five patients underwent OHT during the pandemic. They were all males, ranging from 30 to 59 years of age. Two were transplanted at United Network of Organ Sharing Status 1 or 2, 1 at Status 3, and 2 at Status 4. All were successfully discharged and are alive without allograft dysfunction or rejection. One contracted mild COVID-19 after the index hospitalization. CONCLUSION: OHT recipients with COVID-19 appear to have outcomes similar to the general population hospitalized with COVID-19. OHT during the pandemic is feasible when appropriate precautions are taken. Further study is needed to guide immunosuppression management in OHT recipients affected by COVID-19. (C) 2020 International Society for Heart and Lung Transplantation. All rights reserved.

【 授权许可】

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