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Journal of Heart and Lung Transplantation ; 41(4):S459, 2022.
Article in English | EMBASE | ID: covidwho-1796806


Introduction: Extracorporeal photophoresis (ECP) has been used for select heart transplant (HT) recipients with acute cellular rejection, recurrent or refractory rejection, antibody-mediated rejection (AMR) and as prophylactic therapy. Effects of ECP on coronary allograft vasculopathy (CAV) are not as well-described. Case Report: A 48 year-old man with a history of familial cardiomyopathy required left ventricular assist device therapy and ultimately HT in 2001. He developed ISHLT CAV 1 (40% stenosis of LCx and RCA) with severe microvascular dysfunction detected on PET scan (MFR Total 1.14, LAD 1.11, LCx 0.98, RCA 1.40). He was started on treatment with everolimus, but progressive chronic kidney disease necessitated a change back to mycophenolate mofetil. Following this change, his chronic Class II DSA increased significantly and his renal function worsened requiring dialysis, during which time he also had COVID-19. He then presented in cardiogenic shock with ISHLT CAV 3 and pAMR 2 in July 2020 and was treated with an IABP, plasmapheresis, and thymoglobulin. He had recurrent pAMR 2 three months later, for which he was treated with plasmapheresis, bortezomib, rituximab, and ECP. Prior to initiation of ECP, his coronary angiogram demonstrated rapidly progressive ISHLT CAV 3 (80% proximal LAD, 80% ostial LCx, 70% OM1, and 80% mid RCA). Right heart catheterization demonstrated restrictive filling pressures and echocardiogram demonstrated normal graft systolic function. Four months following initiation of ECP therapy, repeat coronary angiography showed improvement of his CAV: the stenosis in the pLAD had regressed to 50%, the proximal LCX stenosis had regressed to 50%, and disease in the distal circumflex artery had also improved (Figure). In our patient, ECP along with multiple other therapies was associated with significant regression of CAV. Even many years post-HT, CAV may be amenable to some therapies.

The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation ; 41(4):S338-S338, 2022.
Article in English | EuropePMC | ID: covidwho-1781930


Purpose Heart transplant (HT) recipient are at increased risk of adverse outcomes following COVID-19 infection and may benefit from monoclonal antibody infusion to mitigate progression to clinically severe disease. The aim of this study is to describe the outcomes of HT patients who experienced mild to moderate coronavirus disease 2019 (COVID-19), with subsequent administration of casirivimab plus imdevimab administration. Methods A retrospective review of all HT recipients who were infected with COVID-19, and subsequently infused with monoclonal antibodies in a large academic medical center between January 1, 2021 to September 1, 2021. Results 14 HT patients were included in the analysis. The median age was 57.5 (interquartile range [IQR], 41.5-64) years, 10 (71%) were men, and median time from HT was 3.48 (IQR, 1.00-11.82) years. Comorbid conditions included hypertension in 6 patients (43%), diabetes in 4 (29%), and chronic kidney disease in 6 (43%). Eight patients (57%) were previously vaccinated, predominantly with the Pfizer-BioNTech vaccine. Three participants (21%) were admitted after clinical progression of COVID-19. Among patients managed at the study institution, mycophenolate mofetil was discontinued in two patients (14%) and calcineurin inhibitor was maintained at previous levels in all fourteen patients (100%). Of the admitted patients, 1 was treated with high dose corticosteroids alone and 2 were treated with corticosteroids plus remdesivir. No patient required intubation. All 3 patients were discharged home and no patients in this cohort died. Conclusion In this single-center case series, HT patients with mild-moderate COVID-19 who were treated with monoclonal antibody infusion had a hospitalization rate of 21% and 100% survival. Further studies are required to optimize management of COVID-19 infection in the HT population.

Journal of Heart and Lung Transplantation ; 40(4):S210-S211, 2021.
Article in English | Web of Science | ID: covidwho-1187632
Journal of Heart and Lung Transplantation ; 40(4):S117-S118, 2021.
Article in English | Web of Science | ID: covidwho-1187393
The Journal of Heart and Lung Transplantation ; 40(4, Supplement):S243, 2021.
Article in English | ScienceDirect | ID: covidwho-1141806


Purpose In the current era, televisits have become requisite to assess patients and monitor their conditions. Heart transplant (HT) recipients represent a complex population with multiple co-morbidities that require frequent evaluation. This study aimed to assess the effectiveness of televist encounters in a post-heart transplant cohort during the COVID-19 pandemic. Methods This was a prospective cohort study of all HT recipients evaluated via a televist between 3/1/20-5/30/20, at a large academic medical center. Patient demographics, baseline medications and details of televisit encounters were collected from electronic medical records. Patients were followed for 3-months from their first televisit for medication changes, in-person visits, hospital admissions, treated rejection or infection episodes and mortality. Results 301 patients were enrolled, mean age was 56.0±15.1 years and 213 were males (71%). Mean time between transplant and first televisit was 49 months. The number of televisits per patient is seen in Figure 1a. Following-televisits 152 patients (50.5%) had medication changes, mostly immunosuppression (43.5%) followed by diuretics (6.0%). 141 patients (46.8%) were seen in person for either a clinic visit or RHC following a televisit. There were 61 ED visits resulting in 42 admissions in 36 patients (12.0%) (Figure 1b). Of those, 17 occurred within 2 weeks of a televisit (40.5%). There were 8 cardiac related admissions (19.0%, 5 due to treated rejection), 14 (33.3%) due to infection, and 6 due to COVID-19. One patient died due to complications of COVID-19 during the study period. Conclusion In this post HT cohort, there was a high rate of admissions, with most readmissions due to non-cardiac or infectious causes. This study calls into question the role of televisits in this complex patient population and merits further study of how they can best supplement usual care to enhance outcomes in patients post-HT.