Treatment and Outcome of COVID-19 after Heart Transplantation: Update from a German Transplant Center

ABSTRACT

Background: The SARS-CoV-2 pandemic is leading to hospitalizations and increased mortality worldwide. With potentially high prevalence and severity of COVID-19 in cardiac transplantation, there is a great need to generate data in this at-risk cohort. We report here our experience on outcome and treatment of heart transplant recipients infected with SARS-CoV-2 at a German transplant center longitudinally over the previous pandemic waves. Method(s) All adult patients who had received a heart transplant at our center and had confirmed COVID-19 infection between December 2020 and July 2022 (n = 48) were included and retrospectively characterized. Result(s) The median age was 60.5 (46.3-63.8) years, and the majority were male (83%). The hospitalization rate was 83%. Comorbidities included diabetes (31%), arterial hypertension (73%), and chronic renal failure (90%). The percentage of SARS-CoV-2 positive patients since the beginning of our vaccination campaign (03/2021) was 90%, while from those 43 patients, 88% were fully vaccinated at the time of infection (vaccine breakthrough). The median time from vaccination to infection within those patients was 138 (85-225) days. Antiviral therapy was given in 83% of all cases, and passive immunization (convalescent plasma/monoclonal antibodies) was performed in 98% of all cases. Oxygen administration was required in 10% of patients;only one patient required noninvasive ventilation (2%), and no patient required invasive ventilation or mechanical cardiovascular support (ECMO). No new cardiovascular or thromboembolic events were found, and we observed no COVID-19-associated mortality. Conclusion(s) Under increasing numbers of vaccinated patients and treatment options, we could not detect severe courses or increased mortality of COVID-19 in heart transplanted patients. Prospective studies are needed to make better prognostic estimates of COVID-19 in (heart) transplanted patients in the future.