COVID‐19 in heart transplant patients: Case reports from Brazil

de Miranda Soriano, Rafaela Vale; Rossi Neto, Joao Manoel; Finger, Marco Aurelio; dos Santos, Carolina Casadei; Lin‐Wang, Hui Tzu

INTRODUCTION: The COVID‐19 pandemic continues, with a late hyperinflammatory phase. The immunosuppressive therapy used in heart transplant patients, in theory, could reduce inflammation thus benefitting patients with COVID‐19. So far, however, there is still very little literature on this subject. METHODS: This is a single‐center retrospective study. We described laboratory parameters and clinical outcomes from 11 heart transplant patients with COVID‐19 assisted at Dante Pazzanese Institute of Cardiology between March and July 2020. RESULTS: Patients with ages between 35 to 79 years, and heart transplantation occurred from 3 to 264 months. The main comorbidities were diabetes mellitus (9/11; 81.8%), hypertension (10/11; 90.9%), and chronic renal disease (6/11; 54.5%). Cyclosporine A was used in 10 (90.9%) patients, mycophenolate mofetil in 9 (81.8%), and mTOR inhibitor in 5 (45.5%). Fever and cough were observed in 8 (72.7%) patients, and dyspnea and gastrointestinal symptoms in 5 (45.5%). Lymphopenia was observed in 10 (90.9%) and thrombocytopenia in 5 (45.5%). The higher level of troponin associated with chest tomography above 50% infiltrates of ground‐glass opacity (GGO) was observed in those with the worst outcomes. Nine patients needed intensive care, and hospital stay ranged from 4 to 21 days, with 2 (18.2%) patients requiring vasopressor drugs and mechanical ventilation, and three patients (27.3%) dying due to COVID‐19 complications. CONCLUSION: Heart transplant patients had the similar symptoms and outcomes as general population; immunosuppressive therapy seems not to have protected them. Patients who presented higher levels of troponin and D‐dimer, associated to greater GGO pulmonary infiltrates had worse outcomes. More studies with larger cohorts may clarify immunosuppressive effects on COVID‐19 outcomes.