Abstract 15035: Managing Covid-19 Amongst Pediatric Heart Transplant Recipients in Sao Paulo, Brazil

Abstract

Introduction: Heart transplant recipients are considered high risk for poor outcomes following Covid-19 infection. However, there is minimal literature on the effects of Covid-19 on this cohort. We provide our centres experience, as a developing nation with limited resources, in the prevention and management of Covid-19 amongst pediatric heart transplant recipients. Methods: 141 pediatric heart transplant recipients are currently followed-up at our centre - Heart Institute (InCor), Sao Paulo Medical School. We monitored this cohort using telephone contact, by which we postponed appointments and gave recommendations to stay home and maintain hygiene. Since March 2020, for any potential organ donations, a screening was conducted of the donor by taking a history, a RT-PCR-Covid 19 swab and performing a chest CT scan. Results: Five pediatric heart transplant recipients were suspected to have Covid-19 disease and two were tested positive for Covid-19. The first patient was a 14-year-old girl who underwent heart re-transplantation for coronary artery vasculopathy on March 5th, 2020. She developed significant haemodynamic compromise on post-operative day 45 and was transferred to ICU. Her chest CT showed extensive lung opacities (Figure 1). While attempting to wean her from mechanical ventilation, she had a sudden death. The second patient was a 6-year-old male. He presented to the hospital with vomiting, pyrexia, abdominal pain and nasal congestion. His chest CT scan demonstrated small nodule opacification of the lungs. He was appropriately commenced on fluids, antibiotics and antiviral medications. With improvements in his clinical state, he was discharged after 8-days. Conclusions: We provided telehealth to reduce the spread of Covid-19 amongst our cohort. However, we still had two Covid-19 positive cases at our centre. Our observations suggest that pediatric heart transplant recipients are at risk of deleterious outcomes from COVID-19 infection.