COVID-19 in heart transplant recipients: a multi-center analysis of the Northern Italian outbreak

Bottio, Tomaso; Bagozzi, Lorenzo; Fiocco, Alessandro; Nadali, Matteo; Caraffa, Raphael; Bifulco, Olimpia; Ponzoni, Matteo; Lombardi, Carlo Maria; Metra, Marco; Russo, Claudio Francesco; Frigerio, Maria; Masciocco, Gabriella; Potena, Luciano; Loforte, Antonio; Pacini, Davide; Faggian, Giuseppe; Onorati, Francesco; Sponga, Sandro; Livi, Ugolino; Iacovoni, Attilio; Terzi, Amedeo; Senni, Michele; Rinaldi, Mauro; Boffini, Massimo; Marro, Matteo; Jorgji, Vjola; Carrozzini, Massimiliano; Gerosa, Gino

Aims The aim of this study was to assess the clinical course and outcomes of all heart transplant recipients affected by COVID-19 who were followed at the leading heart transplant centers of Northern Italy. Method and Results Since February 2020, we enrolled all 47 cases (79% male) in a first cohort of patients, with a mean age of 61.8 ± 14.5 years, who tested positive for SARS-CoV-2, out of 2676 heart transplant recipients alive before the onset of the COVID-19 pandemic at 7 heart transplant centers in Northern Italy. To date, 38 patients required hospitalization while 9 remained self-home quarantined and 14 died. Compared to the general population, prevalence (18 vs 7 cases per 1000) and related case fatality rate (29.7 vs 15.4%) in heart transplant recipients were doubled. Univariable analysis showed older age (p=0.002), diabetes mellitus (p=0.040), extracardiac arteriopathy (p=0.040), previous PCI (p=0.040), CAV score (p=0.039), lower GFR (p=0.004), and higher NYHA classes (p=0.023) were all significantly associated with in-hospital mortality. During the follow-up two patients died and a third patient has prolonged viral-shedding alternating positive and negative swabs. Since 1st July 2020, we had 6 new patients who tested positive for SARS-CoV-2, 5 patients asymptomatic were self-quarantined, while 1 is still hospitalized for pneumonia. A standard therapy was maintained for all, except for the hospitalized patient. Conclusion The prevalence and mortality of SARS-CoV-2 should spur clinicians to immediately refer heart transplant recipients suspected as having SARS-CoV2 infection to centers specializing in the care of this vulnerable population.