ABSTRACT
To describe the COVID-19 experience among the heart transplant recipient cohort at the West Australian Advanced Heart Failure Cardiac Transplant Unit. Retrospective observational cohort study between January 2020 and October 2022. Primary outcome measures reviewed in digital medical records included hospital admission numbers, disease severity, prevalence of COVID-19 deterioration risk factors, immunisation status, severity of infection, graft function, immunosuppression and treatment regime. The unit supports 152 heart transplant recipients. A total of 35 patients, (23.0%) contracted COVID-19 during the study period. Infection all occurred during the local Omicron wave from February 2022. The cohort had a median age of 55 years (IQR 49-63.5) with a male gender predominance (74.3%). Most patients were classified as mild COVID-19 (n=32, 91.4%) and 74.3% of the cohort were managed in the community with remote monitoring of clinical status. COVID-19 vaccination status at the time of infection up-to-date according to national guidelines for 80.0% of the transplant patients. Only one patient was unvaccinated. Antiviral treatment was predominantly with Molnupiravir (74.3%) with 22.9% of COVID-19 positive heart transplant patients receiving pre-exposure prophylaxis with Evusheld. Of the cohort admitted to hospital (n=9) the mode of oxygen therapy was dominated by nasal cannula (n=4)) followed by non-invasive ventilation (n=1). The median length of stay for the admitted cohort was 4 days (IQR 3-8.5). Four patients had repeat hospital admissions due to COVID-19 throughout the study period. Most patients had stable graft function demonstrated as stable left ventricular ejection fraction on trans-thoracic echocardiogram within six months of COVID-19. 18 patients had monitoring of donor-specific antibody profiling post COVID-19 which demonstrate no antibody increase. COVID-19 in heart transplant recipients in WA was predominately of mild severity, due to infection occurring in a highly vaccinated population with a milder variant. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
To describe the COVID-19 experience among the highly immunosuppressed heart and lung transplant patient cohort at the West Australian Heart and Lung Transplant Unit. Retrospective observational cohort study between January 2020 and October 2022 at the states only quaternary hospital. The WA state heart-lung transplant service supports 297 recipients, 152 under the advanced heart failure unit and 145 patients under the care of the advanced lung disease unit. WA was in a unique position with COVID-19 secondary to border closures, high vaccination rates and community transmission with the Omicron wave. A total of 74 patients (24.9%) across the WA unit contracted COVID-19 during the study period. The median age was 53 years (IQR 42-60) with a male gender predominance (63.5%). The heart transplant cohort had a 23.0% (n=35) COVID-19 infection prevalence. The lung transplant cohort had 31.0% (n=45) COVID-19 positive patients across the study period. Bilateral sequential lung transplants BLST (n=38, 84.4%) was the most common transplant type, followed by heart-lung transplant (n=5, 11.1%) and then single lung transplant (n=2, 4.5%). Most patients across both units were classified as mild COVID-19, with only a small proportion of patients requiring hospitalisation (n=24, 32.4%). Cough (60.0%) and sore throat (55.6%) were the most common initial symptoms reported by the patients. COVID-19 vaccination status at the time of infection was higher than 80%. Pre-exposure prophylaxis was given to 35% of the patients who had COVID-19 infection. Most patients had stable graft function despite COVID-19 as measured by left ventricular ejection fraction on trans-thoracic echocardiogram or forced expiratory volume. Overall the WA COVID-19 case numbers and disease severity in the highly immunocompromised transplant cohort were minimal. Disease severity, morbidity and mortality were low when compared to the predicted modelling for this at-risk cohort released by the Department of Health. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)