ABSTRACT
HT centers may avoid donors with Covid19 (Cov19) infection due to uncertain risk of virus transmission and possibility of virus mediated myocardial injury. We investigated Cov19 donor utilization, transplant characteristics and early post HT outcomes in the U.S. Between May 2020-June 2022, n=27,862 donors in UNOS had data available on Cov19 NAT tests and organ disposition. Since donors may get Cov19 testing multiple times prior to organ retrieval, additional data on multiple Cov19 NAT was requested and analyzed. Donors were classified Cov19-donors if NAT+ at any time during terminal hospitalization, and subclassified as Active Cov19(A-Cov19) if NAT+ at organ procurement and 'Recently Active Cov19' (rA-Cov19) if NAT+ initially but NAT negative prior to organ retrieval. HT outcomes using Cov19 and nonCov19 donors were compared by Kaplan Meier (KM) and Cox hazards ratio (HR). Prior to organ retrieval, 27,862 donors had 60,699 Cov19 NAT tests done. Of these, n=1445 were Cov19 donors, n=125 indeterminate and n=26,292 nonCov19. Of Cov19 donors, n=1017 were A-Cov19 and n=428 rA-Cov19. 309 HTs used hearts from Cov19 donors and 239 (n=150 A-Cov19, n=89 rA-Cov19) met study criteria. Compared to nonCov19, Cov19 donors used for adult HT were younger [30(23-37) vs 32(25-40)yrs] and mostly male (80.3% vs 72.1%), p<0.05. Otherwise, HTs from Cov19 and nonCov19 donors were similar in recipient age, race, etiology, UNOS status, BMI, LVAD, ECMO use;and donor LVEF, and DCD status. HTs from Cov19 and nonCov19 donors had similar survival up to 3 months [CoxHR=1.23(0.63-2.39), p=0.54, adjusted for baseline characteristics, Fig1A]. Survival was also statistically similar in A-Cov19 and rA-Cov19 donor HT cohorts [CoxHR=1.47(0.40-5.48), p=0.56, Fig1B]. HTs from Cov19 donors increased from n=5 in May-Dec 2020 to n=207 in Jan-June 2022, p<0.05 for trend. Data on Cov19 treatment was not available. In the largest analysis to date, HTs from selective Cov19 donors had acceptable early outcomes. Longer follow up is needed. [ABSTRACT 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 abstract 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 abstract. (Copyright applies to all Abstracts.)
ABSTRACT
Myocarditis is a rare complication following mRNA-based COVID vaccinations. While the risk appears to be greatest in adolescent males, increased rates of myocarditis following COVID vaccination have been documented in both sexes and across multiple age groups.In this case, a 59- year-old woman with history of mild COVID infection developed unexplained fatigue, diminished exercise capacity, and intermittent chest discomfort several days after receiving her first dose of the Pfizer-BioNTech COVID-19 vaccine. She was seen in the emergency department at the onset of symptoms and found to have a dynamic troponin elevation peaking at 177 ng/L. A comprehensive workup including regadenoson stress testing, CT scan of the chest with contrast, and ambulatory cardiac monitoring failed to demonstrate an etiology. She subsequently received a second dose of the COVID-19 vaccine which resulted in worsening cardiopulmonary symptoms that persisted over the next several months. Her symptoms were initially attributed to long COVID, and she was provided supportive care and an SSRI for anxiety. After reevaluation in the Cardiology clinic, the patient underwent cardiac MRI revealing edema in the basal lateral wall and late gadolinium enhancement in a subepicardial distribution, suggestive of myocardial inflammation. She was treated with prednisone 50 mg daily and colchicine 0.6 mg twice daily resulting in resolution of chest pain. A repeat MRI performed two weeks later showed complete resolution of myocardial edema with residual subepicardial LGE in the basal lateral wall consistent with prior myocarditis.This case demonstrates the pitfalls of relying on a diagnosis of 'long COVID' to explain concerning cardiac symptoms of uncertain etiology and highlights post-vaccine myocarditis as an important differential in the COVID-19 era. At this time, it is unclear how many patients experience persistent cardiopulmonary symptoms following COVID vaccination and whether a subset of these patients have undiagnosed myocarditis. It is important for clinicians to be alert to the possibility of post vaccine myocarditis in patients presenting with persistent symptoms following vaccination, regardless of demographic profile.