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Coronavirus disease 2019 in heart transplant recipients: Risk factors, immunosuppression, and outcomes.
Genuardi, Michael V; Moss, Noah; Najjar, Samer S; Houston, Brian A; Shore, Supriya; Vorovich, Esther; Atluri, Pavan; Molina, Maria; Chambers, Susan; Sharkoski, Tiffany; Hsich, Eileen; Estep, Jerry D; Owens, Anjali T; Alexander, Kevin M; Chaudhry, Sunit-Preet; Garcia-Cortes, Rafael; Molina, Ezequiel; Rodrigo, Maria; Wald, MDc Joyce; Margulies, Kenneth B; Hanff, Thomas C; Zimmer, Ross; Kilic, Arman; Mclean, Rhondalyn; Vidula, Himabindu; Dodd, Katherine; Blumberg, Emily A; Mazurek, Jeremy A; Goldberg, Lee R; Alvarez-Garcia, Jesus; Mancini, Donna; Teuteberg, Jeffrey J; Tedford, Ryan J; Birati, Edo Y.
  • Genuardi MV; Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: Michael.Genuardi@pennmidicine.upenn.edu.
  • Moss N; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Najjar SS; MedStar Washington Hospital Center, Washington, DC.
  • Houston BA; Medical University of South Carolina, Charleston, SC.
  • Shore S; Cardiovascular Division, University of Michigan, Ann Arbor, MI.
  • Vorovich E; Division of Cardiology, Northwestern University, Chicago, IL.
  • Atluri P; Department of Cardiothoracic Surgery, University of Pennsylvania, Pennsylvania.
  • Molina M; Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Chambers S; Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Sharkoski T; Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Hsich E; Heart and Vascular Institute at the Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH.
  • Estep JD; Heart and Vascular Institute at the Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH.
  • Owens AT; Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Alexander KM; Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA.
  • Chaudhry SP; St. Vincent Medical Group, St. Vincent Heart Center, Indianapolis, IN.
  • Garcia-Cortes R; St. Vincent Medical Group, St. Vincent Heart Center, Indianapolis, IN.
  • Molina E; MedStar Washington Hospital Center, Washington, DC.
  • Rodrigo M; MedStar Washington Hospital Center, Washington, DC.
  • Wald MJ; Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Margulies KB; Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Hanff TC; Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Zimmer R; Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Kilic A; Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
  • Mclean R; Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Vidula H; Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York.
  • Dodd K; Division of Cardiology, Northwestern University, Chicago, IL.
  • Blumberg EA; Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Mazurek JA; Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Goldberg LR; Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania.
  • Alvarez-Garcia J; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Mancini D; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
  • Teuteberg JJ; Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA.
  • Tedford RJ; Medical University of South Carolina, Charleston, SC.
  • Birati EY; Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular division, Poriya Medical Cent
J Heart Lung Transplant ; 40(9): 926-935, 2021 09.
Article in English | MEDLINE | ID: covidwho-1233437
ABSTRACT

BACKGROUND:

COVID-19 continues to inflict significant morbidity and mortality, particularly on patients with preexisting health conditions. The clinical course, outcomes, and significance of immunosuppression regimen in heart transplant recipients with COVID-19 remains unclear.

METHODS:

We included the first 99 heart transplant recipients at participating centers with COVID-19 and followed patients until resolution. We collected baseline information, symptoms, laboratory studies, vital signs, and outcomes for included patients. The association of immunosuppression regimens at baseline with severe disease were compared using logistic regression, adjusting for age and time since transplant.

RESULTS:

The median age was 60 years, 25% were female, and 44% were white. The median time post-transplant to infection was 5.6 years. Overall, 15% died, 64% required hospital admission, and 7% remained asymptomatic. During the course of illness, only 57% of patients had a fever, and gastrointestinal symptoms were common. Tachypnea, oxygen requirement, elevated creatinine and inflammatory markers were predictive of severe course. Age ≥ 60 was associated with higher risk of death and the use of the combination of calcineurin inhibitor, antimetabolite, and prednisone was associated with more severe disease compared to the combination of calcineurin inhibitor and antimetabolite alone (adjusted OR = 7.3, 95% CI 1.8-36.2). Among hospitalized patients, 30% were treated for secondary infection, acute kidney injury was common and 17% required new renal replacement therapy.

CONCLUSIONS:

We present the largest study to date of heart transplant patients with COVID-19 showing common atypical presentations and a high case fatality rate of 24% among hospitalized patients and 16% among symptomatic patients.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Heart Transplantation / COVID-19 / Heart Failure / Immunosuppressive Agents Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: J Heart Lung Transplant Journal subject: Cardiology / Transplantation Year: 2021 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Heart Transplantation / COVID-19 / Heart Failure / Immunosuppressive Agents Type of study: Diagnostic study / Observational study / Prognostic study Topics: Long Covid Limits: Aged / Female / Humans / Male / Middle aged Language: English Journal: J Heart Lung Transplant Journal subject: Cardiology / Transplantation Year: 2021 Document Type: Article