ABSTRACT
BACKGROUND AND METHODS: Heart transplant recipients (HTr) have a higher probability of suffer from severe coronavirus disease-2019 (COVID-19) in comparison to general population, but their risk has changed over the course of the pandemic in relation to various factors. We conducted a prospective study including all HTr at risk of COVID-19 in a tertiary center between February 2020 and October 2022. The aim was to analyze how the prognosis (incidence of pneumonia and mortality) of COVID-19 in HTr has evolved over time, contextualizing variants, vaccination, and other treatments. RESULTS: Of 308 HTr included, 124 got the infection (39.2%). COVID and non-COVID HTr had similar baseline characteristics. COVID-19 patients with pneumonia had a poorer prognosis than those with less severe presentations, with a higher rate of hospitalization (93.3 vs. 14.1%, p < .001) and death (41.0 vs. 1.2%, p < .001). Multivariate analysis identified age ≥60 years (odds ratio [OR] 3.65, 95% confidence interval [CI] 1.16-11.49, p = .027), and chronic kidney disease ≥3a (OR 4.95, 95% CI 1.39-17.54, p = .014) as predictors of pneumonia. Two-dose vaccination (OR 0.20, CI 95% 0.05-0.72, p = .02) and early remdesivir administration (OR 0.17, CI 0.03-0.90, p = .037) were protective factors. Over the course of the pandemic considering three periods in the follow-up (prevaccination February-December 2020, postvaccination January-December 2021, and post early remdesivir indication January-October 2022), we observed a reduction in pneumonia incidence from 62% to 19% (p < .001); and mortality (from 23% to 4%, p < .001). CONCLUSIONS: The prognosis of COVID-19 in HTr has improved over time, likely due to vaccination and early administration of remdesivir.
Subject(s)
COVID-19 , Heart Transplantation , Humans , Middle Aged , COVID-19/epidemiology , COVID-19/prevention & control , Pandemics , SARS-CoV-2 , Prospective Studies , Heart Transplantation/adverse effects , Transplant RecipientsABSTRACT
Spain is a world leader in donation and transplantation. This model has been exported to other countries with favorable results. The objective of this study was to compare the actual donation intention rate with the effective donation figures, and analyze the main reasons why families decline organ donation. To estimate the current donation intention, we conducted 1065 surveys in March 2019, and to calculate effective donation figures in our hospital, we analyzed 1158 interviews conducted with relatives of potential organ donors between 1996 and 2018. Regarding the surveys to estimate donation intention, the mean (standard deviation) age was 51.6 (17-91) years. A total of 58% were women, 26% were health care professionals, and 5.1% were transplant recipients; 89.4% would donate their organs. In the multivariate analysis, having expressed the desire to donate to their family was independently related to the intention to donate (odds ratio, 3.4; 95% confidence interval, 2.2-5.2; P < .001). Regarding the interviews with relatives of potential donors, 79.4% were finally effective donors. The belief that the possible donor would have rejected the organ donation stands out among the causes of decline. However, only one-half of those surveyed expressed the wish to be a donor to their relatives. In the temporal evolution, a greater acceptance of donation is observed in the first period with a reduction over the last years (P > .001). It is our responsibility to improve transplantation rates because our model has shown to save lives and it is a role model for other nations, promoting information activities that encourage greater discussion of organ donation within families.
Subject(s)
Organ Transplantation , Tissue and Organ Procurement , Aged , Aged, 80 and over , Female , Health Personnel , Humans , Intention , Middle Aged , Tissue DonorsABSTRACT
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