A proposed strategy for management of immunosuppression in heart transplant patients with COVID-19.

Abstract

There is limited experience in management of orthotopic heart transplant (OHT) patients with COVID‐19. In this study, we present our initial experience using a standardized management algorithm. Data collection was performed on OHT patients with COVID‐19 after March 10, 2020 (declaration of state of emergency in Massachusetts). Among the 358 OHT patients currently followed at our program, 5 patients (1.4%) tested positive for COVID‐19 (median age 50 years [IQR, 49‐58], duration post‐OHT 21 years [IQR, 6‐25], and 4 of 5 [80%] were men). Among the 5 OHT patients, 2 of 5 (20%) had mild disease and had no change in baseline immunosuppression therapy. Two of 5 (20%) had moderate disease and received remdesivir as part of a clinical trial and reduced immunosuppression therapy. One patient (20%) died prior to presenting to the hospital, consistent with 20% case fatality rate. Four patients (80%) are doing well 4 weeks post‐discharge. In this small cohort of OHT patients with COVID‐19, we report a 1.4% COVID‐19 infection rate and 20% case fatality rate. All OHT patients managed under our clinical management algorithm had good short‐term outcomes. Further study to estimate the true risk profile of OHT patients and validate the proposed management strategy is warranted.