Challenges in Heart Transplantation during COVID-19: A Single Center Experience

Singhvi, Aditi; Barghash, Maya; Lala, Anuradha; Mitter, Sumeet S.; Parikh, Aditya; Oliveros, Estefania; Rollins, Brett M; Brunjes, Danielle L.; Alvarez-Garcia, Jesus; Johnston, Erika; Ryan, Kieran; Itagaki, Shinobu; Moss, Noah; Pinney, Sean P.; Anyanwu, Anelechi; Mancini, Donna

BACKGROUND: Orthotopic heart transplantation (OHT) recipients may be particularly vulnerable to coronavirus disease (COVID-19). OHT during the pandemic presents unique challenges in terms of feasibility and safety. METHODS: Chart review was performed for consecutive OHT recipients with COVID-19, and waitlisted patients who underwent OHT from March 1, 2020 to May 15, 2020. RESULTS: Of the approximately 400 OHT recipients followed at our institution, 22 acquired COVID-19. Clinical characteristics included median age 59 (Range, 49 - 71) years, 14 (63.6%) were male, and median time from OHT to infection was 4.6 (2.5 – 20.6) years. Symptoms included fever (68.2%), gastrointestinal complaints (55%) and cough (46%). COVID-19 was severe or critical in 5 (23%). All patients had elevated inflammatory biomarkers. Immunosuppression was modified in 85% patients. Most (n=16, 86.4%) were hospitalized, 18% required intubation, and 14% required vasopressor support. Five patients (23%) expired. None of the patients requiring intubation survived. 5 patients underwent OHT during the pandemic. They were all males, ranging 30 to 59 years of age. Two were transplanted at UNOS status 1 or 2, one at status 3, and two at status 4. All were successfully discharged and are alive without allograft dysfunction or rejection. One contracted mild COVID-19 after the index hospitalization. CONCLUSION: OHT recipients with COVID-19 appear to have outcomes similar to the general population hospitalized with COVID-19. OHT during the pandemic is feasible when appropriate precautions are taken. Further study is needed to guide immunosuppression management in OHT recipients affected by COVID-19.