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 ¼ 0.002), diabetes mellitus (p ¼ 0.040), extracardiac arteriopathy (p ¼ 0.040), previous PCI (p ¼ 0.040), CAV score (p ¼ 0.039), lower GFR (p ¼ 0.004), and higher NYHA functional classes (p ¼ 0.023) were all significantly associated with in-hospital mortality. During the followup 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. (J Am Coll Cardiol HF 2021;9:52–61) © 2021 by the American College of Cardiology Foundation.
COVID-19 in Heart Transplant Recipients: A Multicenter Analysis of the Northern Italian Outbreak
Bottio T;
2020-01-01
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 ¼ 0.002), diabetes mellitus (p ¼ 0.040), extracardiac arteriopathy (p ¼ 0.040), previous PCI (p ¼ 0.040), CAV score (p ¼ 0.039), lower GFR (p ¼ 0.004), and higher NYHA functional classes (p ¼ 0.023) were all significantly associated with in-hospital mortality. During the followup 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. (J Am Coll Cardiol HF 2021;9:52–61) © 2021 by the American College of Cardiology Foundation.File | Dimensione | Formato | |
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