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Multicenter Study
. 2020 Dec;109(12):1531-1539.
doi: 10.1007/s00392-020-01722-w. Epub 2020 Aug 11.

COVID-19 among heart transplant recipients in Germany: a multicenter survey

Rasmus Rivinius  1   2 , Ziya Kaya  1   2 , René Schramm  3 , Udo Boeken  4 , Zdenek Provaznik  5 , Christian Heim  6 , Christoph Knosalla  7   8 , Felix Schoenrath  7   8 , Andreas Rieth  9 , Michael Berchtold-Herz  10 , Markus J Barten  11 , Dominic Rauschning  12 , Victoria T Mücke  13 , Stephan Heyl  14 , Rudin Pistulli  15 , Carola Grinninger  16   17 , Christian Hagl  16   17 , Jan F Gummert  3 , Gregor Warnecke  2   18 , P Christian Schulze  19 , Hugo A Katus  1   2 , Michael M Kreusser #  20   21   22 , Philip W Raake #  1   2
Affiliations
Multicenter Study

COVID-19 among heart transplant recipients in Germany: a multicenter survey

Rasmus Rivinius et al. Clin Res Cardiol. 2020 Dec.

Abstract

Aims: Heart transplantation may represent a particular risk factor for severe coronavirus infectious disease 2019 (COVID-19) due to chronic immunosuppression and frequent comorbidities. We conducted a nation-wide survey of all heart transplant centers in Germany presenting the clinical characteristics of heart transplant recipients with COVID-19 during the first months of the pandemic in Germany.

Methods and results: A multicenter survey of all heart transplant centers in Germany evaluating the current status of COVID-19 among adult heart transplant recipients was performed. A total of 21 heart transplant patients with COVID-19 was reported to the transplant centers during the first months of the pandemic in Germany. Mean patient age was 58.6 ± 12.3 years and 81.0% were male. Comorbidities included arterial hypertension (71.4%), dyslipidemia (71.4%), diabetes mellitus (33.3%), chronic kidney failure requiring dialysis (28.6%) and chronic-obstructive lung disease/asthma (19.0%). Most patients received an immunosuppressive drug regimen consisting of a calcineurin inhibitor (71.4%), mycophenolate mofetil (85.7%) and steroids (71.4%). Eight of 21 patients (38.1%) displayed a severe course needing invasive mechanical ventilation. Those patients showed a high mortality (87.5%) which was associated with right ventricular dysfunction (62.5% vs. 7.7%; p = 0.014), arrhythmias (50.0% vs. none; p = 0.012), and thromboembolic events (50.0% vs. none; p = 0.012). Elevated high-sensitivity cardiac troponin T- and N-terminal prohormone of brain natriuretic peptide were significantly associated with the severe form of COVID-19 (p = 0.017 and p < 0.001, respectively).

Conclusion: Severe course of COVID-19 was frequent in heart transplanted patients. High mortality was associated with right ventricular dysfunction, arrhythmias, thromboembolic events, and markedly elevated cardiac biomarkers.

Keywords: COVID-19; Heart transplantation; Immunosuppression; Mortality.

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Conflict of interest statement

The authors report no conflicts of interest in this work.

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