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Coronavirus disease 2019 in heart transplant recipients: Risk factors, immunosuppression, and outcomes.

MedStar author(s):

1053-2498

Name of journal: The Journal of heart and lung transplantation : the official publication of the International Society for Heart TransplantationAbstract: BACKGROUND: COVID-19 continues to inflict significant morbidity and mortality, particularly on patients with preexisting health conditions. The clinical course, outcomes, and significance of immunosuppression regimen in heart transplant recipients with COVID-19 remains unclear.CONCLUSIONS: We present the largest study to date of heart transplant patients with COVID-19 showing common atypical presentations and a high case fatality rate of 24% among hospitalized patients and 16% among symptomatic patients. Copyright (c) 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.METHODS: We included the first 99 heart transplant recipients at participating centers with COVID-19 and followed patients until resolution. We collected baseline information, symptoms, laboratory studies, vital signs, and outcomes for included patients. The association of immunosuppression regimens at baseline with severe disease were compared using logistic regression, adjusting for age and time since transplant.RESULTS: The median age was 60 years, 25% were female, and 44% were white. The median time post-transplant to infection was 5.6 years. Overall, 15% died, 64% required hospital admission, and 7% remained asymptomatic. During the course of illness, only 57% of patients had a fever, and gastrointestinal symptoms were common. Tachypnea, oxygen requirement, elevated creatinine and inflammatory markers were predictive of severe course. Age >= 60 was associated with higher risk of death and the use of the combination of calcineurin inhibitor, antimetabolite, and prednisone was associated with more severe disease compared to the combination of calcineurin inhibitor and antimetabolite alone (adjusted OR = 7.3, 95% CI 1.8-36.2). Among hospitalized patients, 30% were treated for secondary infection, acute kidney injury was common and 17% required new renal replacement therapy.All authors: Alexander KM, Alvarez-Garcia J, Atluri P, Birati EY, Blumberg EA, Chambers S, Chaudhry SP, Dodd K, Estep JD, Garcia-Cortes R, Genuardi MV, Goldberg LR, Hanff TC, Houston BA, Hsich E, Kilic A, Mancini D, Margulies KB, Mazurek JA, Mclean R, Molina E, Molina M, Moss N, Najjar SS, Owens AT, Rodrigo M, Sharkoski T, Shore S, Tedford RJ, Teuteberg JJ, Vidula H, Vorovich E, Wald MJ, Zimmer ROriginally published: Journal of Heart & Lung Transplantation. 2021 May 19Fiscal year: FY2022 Fiscal year of original publication: FY2021Digital Object Identifier:

https://dx.doi.org/10.1016/j.healun.2021.05.006

Date added to catalog: 2021-07-19

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Title notes ( 6 )

Holdings
Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	34140222	Available		34140222

Available online from MWHC library: 1999 - present, Available in print through MWHC library:1999-2007

BACKGROUND: COVID-19 continues to inflict significant morbidity and mortality, particularly on patients with preexisting health conditions. The clinical course, outcomes, and significance of immunosuppression regimen in heart transplant recipients with COVID-19 remains unclear.

CONCLUSIONS: We present the largest study to date of heart transplant patients with COVID-19 showing common atypical presentations and a high case fatality rate of 24% among hospitalized patients and 16% among symptomatic patients. Copyright (c) 2021 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

METHODS: We included the first 99 heart transplant recipients at participating centers with COVID-19 and followed patients until resolution. We collected baseline information, symptoms, laboratory studies, vital signs, and outcomes for included patients. The association of immunosuppression regimens at baseline with severe disease were compared using logistic regression, adjusting for age and time since transplant.

RESULTS: The median age was 60 years, 25% were female, and 44% were white. The median time post-transplant to infection was 5.6 years. Overall, 15% died, 64% required hospital admission, and 7% remained asymptomatic. During the course of illness, only 57% of patients had a fever, and gastrointestinal symptoms were common. Tachypnea, oxygen requirement, elevated creatinine and inflammatory markers were predictive of severe course. Age >= 60 was associated with higher risk of death and the use of the combination of calcineurin inhibitor, antimetabolite, and prednisone was associated with more severe disease compared to the combination of calcineurin inhibitor and antimetabolite alone (adjusted OR = 7.3, 95% CI 1.8-36.2). Among hospitalized patients, 30% were treated for secondary infection, acute kidney injury was common and 17% required new renal replacement therapy.

English