Clinical course and challenging management of early COVID-19 infection after heart transplantation: case report of two patients

Tchana-Sato, Vincent; Ancion, Arnaud; Tridetti, Julien; Sakalihasan, Natzi; Hayette, Marie Pierre; Detry, Olivier; Delvenne, Philippe; Amabili, Philippe; Senard, Marc; Hougrand, Olivier; Szecel, Delphine; Lavigne, Jean-Paul; Minga Lowampa, Elie; Ponte, Charlotte; Maquoi, Isabelle; Morimont, Philippe; Van Den Bulck, Melissa; Delbouille, Marie Helene; Defraigne, Jean Olivier; Lancellotti, Patrizio

BACKGROUND: There are limited data on Coronavirus disease 2019 (COVID-19) in solid organ transplant patients, especially in heart transplant recipients, with only a few case reports and case series described so far. Heart transplant recipients may be at particular high risk due to their comorbidities and immunosuppressed state. CASE PRESENTATION: This report describes the clinical course and the challenging management of early COVID-19 infection in two heart transplant recipients who tested positive for the SARS-CoV-2 virus in the perioperative period of the transplant procedure. The two patients developed a severe form of the disease and ultimately died despite the initiation of an antiviral monotherapy with hydroxychloroquine coupled with the interruption of mycophenolate mofetil. CONCLUSIONS: These two cases illustrate the severity and poor prognosis of COVID-19 in the perioperative period of a heart transplant. Thorough screening of donors and recipients is mandatory, and the issue of asymptomatic carriers needs to be addressed. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-021-05793-6.