Clinical manifestations and outcomes of coronavirus disease-19 in heart transplant recipients: a multicentre case series with a systematic review and meta-analysis

Abstract

Available data on clinical presentation and mortality of coronavirus disease-2019 (COVID-19) in heart transplant (HT) recipients remain limited. We report a case series of laboratory-confirmed COVID-19 in 39 HT recipients from 3 French heart transplant centres (mean age 54.4 ± 14.8 years; 66.7% males). Hospital admission was required for 35 (89.7%) cases including 14/39 (35.9%) cases being admitted in intensive care unit. Immunosuppressive medications were reduced or discontinued in 74.4% of the patients. After a median follow-up of 54 (19-80) days, death and death or need for mechanical ventilation occurred in 25.6% and 33.3% of patients, respectively. Elevated C-reactive protein and lung involvement ≥50% on chest computed tomography (CT) at admission were associated with an increased risk of death or need for mechanical ventilation. Mortality rate from March to June in the entire 3-centre HT recipient cohort was 56% higher in 2020 compared to the time-matched 2019 cohort (2% vs. 1.28%, P = 0.15). In a meta-analysis including 4 studies, pre-existing diabetes mellitus (OR 3.60, 95% CI 1.43-9.06, I² = 0%, P = 0.006) and chronic kidney disease stage III or higher (OR 3.79, 95% CI 1.39-10.31, I² = 0%, P = 0.009) were associated with increased mortality. These findings highlight the aggressive clinical course of COVID-19 in HT recipients.

Keywords: COVID-19; heart transplant; immunosuppressive medication.

Figure 1

Heart transplant recipient survival from March to June 2019 and March to June 2020.

Figure 2

Demographics and comorbidities according to occurrence of death in heart transplant recipients with COVID‐19. ACE‐I, angiotensin‐converting enzyme inhibitors; ARB, angiotensin receptor blockers; CAV, cardiac allograft vasculopathy; CKD, chronic kidney disease; COVID‐19, coronavirus disease 2019; DM, diabetes mellitus; ISHLT, International Society for Heart and Lung Transplantation; M‐H, Mantel‐Haenszel. For the impact of CKD and number of background immunosuppressive therapy, data presented for Bottio et al. [52], are from the study by Iacovoni et al. [17], which were eventually included in the study of Bottio et al.