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Comparative Study
. 2020 Oct;39(10):1081-1088.
doi: 10.1016/j.healun.2020.06.016. Epub 2020 Jun 26.

A case series of novel coronavirus infection in heart transplantation from 2 centers in the pandemic area in the North of Italy

Attilio Iacovoni  1 , Massimo Boffini  2 , Stefano Pidello  3 , Erika Simonato  4 , Cristina Barbero  4 , Roberta Sebastiani  1 , Claudia Vittori  1 , Alessandra Fontana  1 , Amedeo Terzi  5 , Gaetano Maria De Ferrari  3 , Mauro Rinaldi  4
Affiliations
Comparative Study

A case series of novel coronavirus infection in heart transplantation from 2 centers in the pandemic area in the North of Italy

Attilio Iacovoni et al. J Heart Lung Transplant. 2020 Oct.

Erratum in

  • ERRATUM.
    [No authors listed] [No authors listed] J Heart Lung Transplant. 2020 Dec;39(12):1514. doi: 10.1016/j.healun.2020.10.002. Epub 2020 Oct 14. J Heart Lung Transplant. 2020. PMID: 33069572 Free PMC article. No abstract available.

Abstract

Background: Little is known about the coronavirus SARS-CoV-2 disease (COVID-19) in solid organ transplanted patients. We here report a series of heart transplanted patients with COVID-19 from two centers of Italy.

Methods: All heart transplanted patients of Transplant Centers of Bergamo and Torino with a microbiologically confirmed SARS-CoV-2 infection were enrolled. Data collection included clinical presentation, laboratory and radiological findings, treatment and outcome. Follow-up was performed by visit or phone.

Results: From February to March 2020 twenty-six heart transplanted patients (age 62±12 years; 77% males; time from transplant 10±10 years; 69% with comorbidities) had a microbiologically confirmed COVID-19. The most frequent symptom was fever, followed by cough. Seventeen patients had a pneumonia, 8 of them severe pneumonia. Seven patients died (27%) and 17 (65%) were hospitalized. Discontinuation of immunosuppression was associated with death (71 vs 21%, p=0.02). Conversely, all patients receiving steroids survived (p<0.001). Patients who received heart transplantation during COVID-19 outbreak survived and no acute graft rejection occurred. Patients who died were older than survivors, had a longer time from transplant and a worse clinical presentation at diagnosis. The current regimen enabled the prolonged survival and function of orthotopic cardiac xenografts in altogether 6 of 8 baboons, of which 4 were now added. These results exceed the threshold set by the Advisory Board of the International Society for Heart and Lung Transplantation.

Conclusions: COVID-19 has a significant impact on long term heart transplanted patients. Conversely, SARS-CoV-2 infection seems to have a limited influence on more recent transplants. Our experience may suggest that heart transplantation programs can be maintained even during the pandemic phase if specific and tailored paths to prevent and to limit virus transmission are provided.

Keywords: COVID-19; Northern Italy; coronavirus; epidemiology; heart transplantation.

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Conflict of interest statement

Disclosure statement The authors have no conflicts of interest to disclose. No funding sources were received.

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