Abstract
AimsHeart transplantation may represent a particular risk factor for severe coronavirus infectious disease 2019 (COVID-19) due to chronic immunosuppression and frequent comorbidities. We conducted a nation-wide survey of all heart transplant centers in Germany presenting the clinical characteristics of heart transplant recipients with COVID-19 during the first months of the pandemic in Germany.Methods and resultsA multicenter survey of all heart transplant centers in Germany evaluating the current status of COVID-19 among adult heart transplant recipients was performed. A total of 21 heart transplant patients with COVID-19 was reported to the transplant centers during the first months of the pandemic in Germany. Mean patient age was 58.6 ± 12.3 years and 81.0% were male. Comorbidities included arterial hypertension (71.4%), dyslipidemia (71.4%), diabetes mellitus (33.3%), chronic kidney failure requiring dialysis (28.6%) and chronic-obstructive lung disease/asthma (19.0%). Most patients received an immunosuppressive drug regimen consisting of a calcineurin inhibitor (71.4%), mycophenolate mofetil (85.7%) and steroids (71.4%). Eight of 21 patients (38.1%) displayed a severe course needing invasive mechanical ventilation. Those patients showed a high mortality (87.5%) which was associated with right ventricular dysfunction (62.5% vs. 7.7%; p = 0.014), arrhythmias (50.0% vs. none; p = 0.012), and thromboembolic events (50.0% vs. none; p = 0.012). Elevated high-sensitivity cardiac troponin T- and N-terminal prohormone of brain natriuretic peptide were significantly associated with the severe form of COVID-19 (p = 0.017 and p < 0.001, respectively).ConclusionSevere course of COVID-19 was frequent in heart transplanted patients. High mortality was associated with right ventricular dysfunction, arrhythmias, thromboembolic events, and markedly elevated cardiac biomarkers.
Highlights
With to date at least 4,440,000 cases of coronavirus infectious disease 2019 (COVID-19) worldwide and estimated 302,000 deaths by June 2020, the pandemic caused by the new coronavirus SARS-CoV-2
A total of 21 heart transplant recipients diagnosed with COVID-19 could be identified across all heart transplant centers in Germany in a period between March and June 2020
Three patients were treated at community-based hospitals, whereas 18 patients were treated at transplant centers
Summary
With to date at least 4,440,000 cases of coronavirus infectious disease 2019 (COVID-19) worldwide and estimated 302,000 deaths by June 2020, the pandemic caused by the new coronavirus SARS-CoV-2 Extended author information available on the last page of the article syndrome coronavirus 2) binds the attention of the international community and medical professionals all over the world [1,2,3,4,5]. As this pandemic continues to unfold across continents, data on the clinical characteristics and outcomes of COVID-19 patients are urgently demanded [6]. Mortality rates were reported with a wide range from 1% to up to 49% in elderly and comorbid patient cohorts [8, 9]. Risk factors for mortality include the presence of comorbidities such as hypertension, diabetes,
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