Coronavirus disease 2019 (COVID-19) and Heart Transplantation: Single Center Experience and Review of the Literature.

ABSTRACT

COVID-19 was declared a global pandemic in March 2020, and since then it has had a significant impact on healthcare including on solid-organ transplantation. Based on age, immunosuppression and prevalence of chronic comorbidities, heart transplant recipients are at high risk of adverse outcomes associated with COVID-19. In our center, 31 heart transplant patients were diagnosed with COVID-19 from March 2020 to September 2021. They required hospitalization (39%), intensive care (10%) and mechanical ventilation (6%) of patients with overall short-term mortality of 3%. Early outpatient use of anti-SARS-CoV-2 monoclonal antibodies in our heart transplant recipients was associated with a reduction in the risk of hospitalization, need for intensive care, and death related to COVID-19. In prior multicenter studies, completed in different geographic areas and pandemic timeframes, diverse rates of hospitalization (38-91%), mechanical ventilation (4-38%) and death (16-33%) have been reported. Progression of disease and adverse outcomes were most significantly associated with severity of lymphopenia, chronic co-morbid conditions like older age, chronic allograft vasculopathy, increased body mass index as well as intensity of baseline immune-suppression. In this article, we also review the current roles and limitations of vaccination, anti-viral agents, and anti-SARS-CoV-2 monoclonal antibodies in the management of heart transplant recipients. Our single center experience, considered together with other studies indicates a trend toward improved outcomes among heart transplant patients with COVID-19.