Observational Study

. 2021 Jan;9(1):52-61.

doi: 10.1016/j.jchf.2020.10.009. Epub 2020 Oct 29.

COVID-19 in Heart Transplant Recipients: A Multicenter Analysis of the Northern Italian Outbreak

Tomaso Bottio¹, Lorenzo Bagozzi², Alessandro Fiocco², Matteo Nadali², Raphael Caraffa², Olimpia Bifulco², Matteo Ponzoni², Carlo Maria Lombardi³, Marco Metra³, Claudio Francesco Russo⁴, Maria Frigerio⁵, Gabriella Masciocco⁵, Luciano Potena⁶, Antonio Loforte⁶, Davide Pacini⁶, Giuseppe Faggian⁷, Francesco Onorati⁷, Sandro Sponga⁸, Ugolino Livi⁸, Attilio Iacovoni⁹, Amedeo Terzi⁹, Michele Senni⁹, Mauro Rinaldi¹⁰, Massimo Boffini¹⁰, Matteo Marro¹⁰, Vjola Jorgji¹¹, Massimiliano Carrozzini⁴, Gino Gerosa²

Affiliations

¹ Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy. Electronic address: tbottio@gmail.com.
² Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
³ Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy.
⁴ Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, Niguarda Hospital, Milan, Italy.
⁵ Transplant Cardiology Unit, Cardiac Thoracic and Vascular Department, Niguarda Hospital, Milan, Italy.
⁶ Cardiac, Thoracic, Vascular and Transplant Department, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy.
⁷ Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy.
⁸ Cardiac Surgery Department, University of Udine, Udine, Italy.
⁹ Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy.
¹⁰ Division of Cardiac Surgery, Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.
¹¹ Hacohen Lab, Massachusetts General Hospital, Boston, Massachusetts, USA.

PMID: 33309578
PMCID: PMC7604081
DOI: 10.1016/j.jchf.2020.10.009

Observational Study

COVID-19 in Heart Transplant Recipients: A Multicenter Analysis of the Northern Italian Outbreak

Tomaso Bottio et al. JACC Heart Fail. 2021 Jan.

. 2021 Jan;9(1):52-61.

doi: 10.1016/j.jchf.2020.10.009. Epub 2020 Oct 29.

Authors

Affiliations

¹ Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy. Electronic address: tbottio@gmail.com.
² Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
³ Cardiology, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy.
⁴ Cardiac Surgery Unit, Cardiac Thoracic and Vascular Department, Niguarda Hospital, Milan, Italy.
⁵ Transplant Cardiology Unit, Cardiac Thoracic and Vascular Department, Niguarda Hospital, Milan, Italy.
⁶ Cardiac, Thoracic, Vascular and Transplant Department, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy.
⁷ Division of Cardiac Surgery, Department of Surgery, University of Verona, Verona, Italy.
⁸ Cardiac Surgery Department, University of Udine, Udine, Italy.
⁹ Cardiovascular Department, ASST Papa Giovanni XXIII, Bergamo, Italy.
¹⁰ Division of Cardiac Surgery, Department of Surgical Sciences, Città della Salute e della Scienza, University of Turin, Turin, Italy.
¹¹ Hacohen Lab, Massachusetts General Hospital, Boston, Massachusetts, USA.

PMID: 33309578
PMCID: PMC7604081
DOI: 10.1016/j.jchf.2020.10.009

Abstract

Objectives: The aim of this study was to assess the clinical course and outcomes of all heart transplant recipients affected by coronavirus disease-2019 (COVID-19) who were followed at the leading heart transplant centers of Northern Italy.

Background: The worldwide severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) pandemic has created unprecedented challenges for public health, demanding exceptional efforts for the successful management and treatment of affected patients. Heart transplant patients represent a unique cohort of chronically immunosuppressed subjects in which SARS-CoV-2 may stimulate an unpredictable clinical course of infection.

Methods: Since February 2020, we enrolled all 47 cases (79% male) in a first cohort of patients, with a mean age of 61.8 ± 14.5 years, who tested positive for SARS-CoV-2, out of 2,676 heart transplant recipients alive before the onset of the COVID-19 pandemic at 7 heart transplant centers in Northern Italy.

Results: To date, 38 patients required hospitalization while 9 remained self-home quarantined and 14 died. Compared to the general population, prevalence (18 vs. 7 cases per 1,000) and related case fatality rate (29.7% vs. 15.4%) in heart transplant recipients were doubled. Univariable analysis showed older age (p = 0.002), diabetes mellitus (p = 0.040), extracardiac arteriopathy (p = 0.040), previous PCI (p = 0.040), CAV score (p = 0.039), lower GFR (p = 0.004), and higher NYHA functional classes (p = 0.023) were all significantly associated with in-hospital mortality. During the follow-up two patients died and a third patient has prolonged viral-shedding alternating positive and negative swabs. Since July 1st, 2020, we had 6 new patients who tested positive for SARS-CoV-2, 5 patients asymptomatic were self-quarantined, while 1 is still hospitalized for pneumonia. A standard therapy was maintained for all, except for the hospitalized patient.

Conclusions: The prevalence and mortality of SARS-CoV-2 should spur clinicians to immediately refer heart transplant recipients suspected as having SARS-CoV2 infection to centers specializing in the care of this vulnerable population.

Keywords: COVID-19 and heart transplant recipients; SARS-CoV-2; heart transplantation; immunosuppressive therapy.

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Conflict of interest statement

Author Disclosures The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

**Central Illustration**
SARS-CoV-2 in Heart Transplant Recipients: A Multicenter Analysis in Northern Italy COVID-19 = coronavirus disease-2019; SARS-CoV-2 = severe acute respiratory syndrome-coronavirus-2.

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Comment in

Courage in the Face of Catastrophe: COVID-19 in Heart Transplant Recipients Northern Italian Registry.
Costanzo MR. Costanzo MR. JACC Heart Fail. 2021 Jan;9(1):62-64. doi: 10.1016/j.jchf.2020.11.004. JACC Heart Fail. 2021. PMID: 33384063 Free PMC article.

References

1. Istituto Superiore di Sanità Sorveglianza Integrata COVID-19 in Italia, aggiornamento del 30 Giugno 2020. https://www.epicentro.iss.it/coronavirus/sars-cov-2-dashboard Available at:
1. Li F., Cai J., Dong N. First cases of COVID-19 in heart transplantation from China. J Heart Lung Transplant. 2020;39:496–497. - PMC - PubMed
1. Latif F., Farr M.A., Clerkin K.J., et al. Characteristics and outcomes of recipients of heart transplant with coronavirus disease 2019. JAMA Cardiol. 2020 May 13 (E-pub ahead of print] - PMC - PubMed
1. Mehta P., McAuley D.F., Brown M., et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet. 2020;395:1033–1034. - PMC - PubMed
1. Pereira M.R., Mohan S., Cohen D.J., et al. COVID-19 in solid organ transplant recipients: initial report from the US epicenter. Am J Transplant. 2020;20:1800–1808. - PMC - PubMed

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COVID-19 in Heart Transplant Recipients: A Multicenter Analysis of the Northern Italian Outbreak

Affiliations

COVID-19 in Heart Transplant Recipients: A Multicenter Analysis of the Northern Italian Outbreak

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Other Literature Sources

Medical

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