Abstract 13306: Predictors of All-Cause Mortality in Heart Transplant Recipients With COVID-19

Abstract

Introduction: Heart transplant recipients are among the most vulnerable to suffer complications from Covid-19, yet there remains no standard of treatment. The primary objective of this study was to identify predictors of all-cause mortality in heart transplant recipients infected with Covid-19 to better tailor management for these medically complex patients. Methods: A retrospective analysis of 28 heart transplant recipients with Covid-19 infections was performed at Loyola University Medical Center, a large tertiary care academic center located in the Chicago metropolitan area. Numerical data was assessed using two-tailed t-tests and bivariate logistical regression. Categorical variables were analyzed using chi-squared tests. Statistical analysis was performed using JMP Pro 15. Results: Between March 1, 2020 and April 30, 2021, 28 heart transplant recipients with Covid-19 sought care at our hospital. The inpatient cohort consisted of 19 patients, 10 (53%) of whom met the primary endpoint of all-cause mortality. Those in the mortality arm (mean age 58.7 ± 21.5 vs 54.3 ± 13.1 in survival arm, p=0.58) were more likely to present closer to symptom onset with an elevated RR, INR, lower MAP, cough, or ESRD. Patients admitted to an ICU with superimposed infections or shock, requiring antibiotics, vasopressors, dialysis, or convalescent plasma were more likely to meet the primary endpoint. Azathioprine appeared protective against all-cause mortality. Conclusions: This is the only known study to assess clinical outcomes in heart transplant recipients based in the American Midwest, a region with a high infection burden but equipped with commensurate clinical resources and access to evolving Covid-directed therapies. Our study demonstrated a considerably high mortality rate (53%) among heart transplant recipients with Covid-19 despite these measures. Further studies are warranted to identify key predictors of mortality in this population to guide management.