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. 2020 Oct;22(5):e13382.
doi: 10.1111/tid.13382. Epub 2020 Jul 8.

COVID-19 in recent heart transplant recipients: Clinicopathologic features and early outcomes

Brian Lima  1 , Gregory T Gibson  2 , Sirish Vullaganti  2 , Kathryn Malhame  1 , Simon Maybaum  2 , Syed T Hussain  1 , Samit Shah  2 , David T Majure  2 , Fran Wallach  3 , Kristine Jang  2 , Vanesa Bijol  4 , Michael J Esposito  4 , Alex K Williamson  4 , Rebecca M Thomas  4 , Tawfiqul A Bhuiya  4 , Harold A Fernandez  1 , Gerin R Stevens  2
Affiliations

COVID-19 in recent heart transplant recipients: Clinicopathologic features and early outcomes

Brian Lima et al. Transpl Infect Dis. 2020 Oct.

Abstract

Background: The impact of COVID-19 on heart transplant (HTx) recipients remains unclear, particularly in the early post-transplant period.

Methods: We share novel insights from our experience in five HTx patients with COVID-19 (three within 2 months post-transplant) from our institution at the epicenter of the pandemic.

Results: All five exhibited moderate (requiring hospitalization, n = 3) or severe (requiring ICU and/or mechanical ventilation, n = 2) illness. Both cases with severe illness were transplanted approximately 6 weeks before presentation and acquired COVID-19 through community spread. All five patients were on immunosuppressive therapy with mycophenolate mofetil (MMF) and tacrolimus, and three that were transplanted within the prior 2 months were additionally on prednisone. The two cases with severe illness had profound lymphopenia with markedly elevated C-reactive protein, procalcitonin, and ferritin. All had bilateral ground-glass opacities on chest imaging. MMF was discontinued in all five, and both severe cases received convalescent plasma. All three recent transplants underwent routine endomyocardial biopsies, revealing mild (n = 1) or no acute cellular rejection (n = 2), and no visible viral particles on electron microscopy. Within 30 days of admission, the two cases with severe illness remain hospitalized but have clinically improved, while the other three have been discharged.

Conclusions: COVID-19 appears to negatively impact outcomes early after heart transplantation.

Keywords: COVID-19; heart transplant.

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Conflict of interest statement

Dr Maybaum reports grants from Abbot and Abiomed, unrelated to this submitted work. Dr Stevens is a consultant for Novartis. The remaining authors have no conflicts of interest to disclose. No funding source was provided for this study.

Figures

FIGURE 1
FIGURE 1
Histopathology in Heart Transplant Recipients with COVID‐19. Patient #1 underwent routine EMBx 4 wk following cardiac transplantation (and 2 wk following nosocomial COVID‐19 infection). (A) H + E ×200 magnification with focus of ISHLT grade 1R (mild) acute cellular rejection. Patient #4 was admitted for severe COVID‐19 illness 8 wk following cardiac transplantation and underwent EMBx 2 wk following COVID‐19 diagnosis. Histologic analysis of the cardiac biopsy specimens revealed no cellular rejection (ISHLT grade 0) and (B) no viral particles were seen by assessment with electron microscopy
See this image and copyright information in PMC

References

    1. Johns Hopkins University COVID‐19 Map ‐ Johns Hopkins Coronavirus Resource Center . Available at: https://coronavirus.jhu.edu/map.html [Accessed May 6, 2020]
    1. Richardson S, Hirsch JS, Narasimhan M, et al. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID‐19 in the New York City area. JAMA. 2020;323(20):2052‐2059. - PMC - PubMed
    1. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497‐506. - PMC - PubMed
    1. Mehra MR, Desai SS, Kuy S, Henry TD, Patel AN. Cardiovascular disease, drug therapy, and mortality in Covid‐19. N Engl J Med. 2020;382(25):e102. - PMC - PubMed
    1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID‐19) outbreak in China: summary of a report of 72314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239. - PubMed

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