Death Rate in Heart Transplant Recipients during the COVID-19 Outbreak in France

Legeai, C.; Jasseron, C.; Cantrelle, C.; Varnous, S.; Para, M.; Epailly, E.; Guendouz, S.; Sebbag, L.; Guillemain, R.; Vermes, E.; Kerbaul, F.; Dorent, R.

Purpose Heart transplant recipients with SARS-CoV-2 infection are at high risk of poor outcomes. Given the high waitlist mortality in heart transplant candidates, the Agence de la biomedecine after discussion with the French scientific societies decided to pursue the transplant program where transplant's capacity was ensured. This study aimed to assess the impact of COVID-19 on heart recipient mortality in France. Methods All heart recipients with SARS-CoV-2 infection reported in the French national registry CRISTAL between February 1st and September 30th 2020 were included in the study (n=86). Patient characteristics were extracted from CRISTAL. Cumulative number of cases by month since February (Figure 1) and case fatality rate (CFR) were calculated. Mortality rates from February to September in the whole 2019 and 2020 recipient cohorts were compared. Survival curves were estimated using Kaplan-Meier method and compared using the log-rank test. Results Of the 86 patients included (median age (IQR) 59 years (46-67), 69% male gender, median time from transplantation 6.9 years (3.0-15.2)) 77% required hospitalization including 39% in ICU. Twenty patients died (CFR: 23%). No difference in 3-month survival was observed between 2020 and 2019 recipient cohorts (98.8% [98.5%-99.1%] versus 99.0% [98.7%-99.2%], respectively) (Figure 2). Conclusion While COVID-19 was associated with high fatality rate in heart transplant recipients, we could not identify an excess mortality in 2020 heart recipient cohort. These findings suggest that continuing heart transplant activity during the COVID-19 pandemic was a reasonable option.