Six-Month Outcomes of Heart Transplant Recipients Infected by COVID-19

Purpose

COVID-19 infection might be associated with higher mortality risk for transplanted patients, as a result of their multiple co-morbidities and their immunosuppressed status. We sought to describe the six-month outcomes of heart transplant (HT) recipients infected by COVID-19.

Methods

We retrospectively analyzed clinical and echocardiographic data from all HT recipients infected with COVID-19 between March and April 2020. All patients were followed for a minimum of 6 months or until death.

Results

Twenty-eight HT patients were studied, median age was 64 (range 59-69) and 22 were male. Co-morbidities included obesity (25%), diabetes (61%), HTN (71%), CKD (68 %) and chronic lung disease (36%). Eight patients died (29%) (non-survivors) and 20 survived (survivors) COVID-19 infection. All patients who survived the initial hospitalization period remained alive at 6 months (figure 1). There was no difference in the prevalence of co-morbidities between survivors and non-survivors. Survivors had lower peak ferritin (2185 ± 793 vs 18023 ± 16724, p= 0.04) and procalcitonin (0.8 ± 0.3 vs 104 ± 31, p<0.005). Baseline allograft function was similar between survivors and non-survivors and it remained unchanged at 6 months for the survivors’ group (LVEF baseline: 58 ± 1% vs LVEF 6 m 61 ± 3%). Renal function returned to baseline in 85% of survivors at 6 months after hospitalization. Mycophenolate mofetil was held during the acute infection and was resumed after discharge. At 6 months follow-up, all patients returned to their baseline immunosuppression regimen, have no further symptoms of COVID-19 and there have been no subsequent rejection events.

Conclusion

COVID-19 infection is associated with a high fatality rate (29%) among HT recipients, however, HT recipients that survive the acute COVID-19 infection have preserved allograft function and end-organ function has returned to baseline at 6 months follow-up.