COVID Infection in Heart Transplant Recipients: Experiences from an Epicenter

Abstract

PurposeHeart transplant (HT) recipients are at significant risk from Covid-19 infection due to immunosuppression and potential effects on graft function. Currently no standard care management strategy exists for this population. We sought to describe our experiences as a single center caring for HT recipients with Covid-19 infection.MethodsRetrospective chart review of 250 adult HT recipients followed at the University of Southern California identified 46 individuals with PCR-proven Covid-19 infection between March 1st, 2020 and October 1st, 2021. Herein, we report on their baseline clinical characteristics, serial echocardiographic parameters, laboratory values and pharmacologic treatment regimens.Results46 HT patients were identified with Covid-19 infection. Patients were more likely to be male (74%), with a mean age of 52.0 years old, and average BMI of 28.71. The most common indications for HT included NICM (54%) and ICM (22%), and comorbidities included HTN (59%), HLD (59%), DM (39%), and CAD (26%). Over a third of patients (37%) had a history of smoking, and 7 patients (15%) were vaccinated against Covid-19. Patients were on average 6.53 (1.1-9.0) years post-transplant, and on three 3 classes of immunosuppressive medications (89%). The most common presenting symptoms were fever (24%), dyspnea (33%), hypoxic respiratory failure (26%), and GI symptoms (20%). Only 8 patients (17%) had evidence of graft injury with mean donor-derived cell free DNA levels of 0.41 (NL <0.12). Mean EF was 60.7% pre- and 59.0% post-infection. The most common treatment was supportive therapy (39%), followed by monoclonal antibody therapy (28%), steroids (24%; dexamethasone or solumedrol) and antibiotics (24%). Reduction in antimetabolites (33%), calcineurin inhibitors (15%), and prednisone (15%) was common. Half of the patients were admitted to the hospital with 11% requiring ICU level of care, and half were managed as outpatients. Only 4 patients died (1 from non-covid related illness 6 months post-infection) yielding a 91% overall survival rate.ConclusionIn a single-center experience over 18 months, 46 HT patients had proven Covid-19 infection. Overall survival was 91% with mainstays of treatment focusing on supportive care and monoclonal antibody therapy. Further research is needed to clarify optimal treatment strategies in HT patients with Covid-19 infection.