COVID-19 and Heart Transplant: A Case Series and Review of the Literature

Abstract

Coronavirus disease 2019 (COVID-19) has resulted in many challenges in patient care, especially among high-risk populations such as heart transplant recipients. Patients with heart transplant experience a significantly higher mortality rate with COVID-19 infection, and management is based on extrapolation from clinical trials done on nontransplant patients and from clinical experience. Here we report 4 cases of patients with heart transplant who presented with COVID-19 infection in late 2020. Patients presented with symptoms similar to those seen in the general population. All 4 patients were admitted to the hospital, and they were all treated with dexamethasone. In addition, 2 patients received remdesivir. Immunosuppressive medications were adjusted to maintain adequate levels of immunosuppression but at the same time allow for an adequate immune response against the infection. All patients were discharged alive from the hospital. We then performed a literature review on studies that included heart transplant patients who developed the infection and developed suggestions for a standardized management approach, which we share in this article.

Fig 1

Flow diagram delineating suggested treatment strategy in heart transplant recipients with COVID-19 infection. CBC, complete blood count; CMP, complete metabolic panel; COVID-19, coronavirus disease 2019; CRP, C-reactive protein; CT, computed tomography; CXR, chest X-Ray; LDH, lactate dehydrogenase; OHT, orthotopic heart transplant; mTOR, mechanistic Target of Rapamycin.