Heart transplantation management in northern Italy during COVID-19 pandemic: single-centre experience

Northern Italy is currently on the front line of European COVID-19 outbreak and the first western region whose solid organ transplant programs have had to face the virus pandemic emergency. Data on heart transplanted patients’ management in the COVID-19 era are still very limited. herefore, the ability to grant best clinical practice in transplant population should answer to crucial questions, mainly regarding immunosuppression-related issues. First, severe infections in the immunocompromised population dramatically influence patient’s prognosis. There is concern for the great variability which dominates the clinical presentation patterns in this population and the risk factors for severe infection have not been fully characterized. Italian Transplant Authority (Centro Nazionale Trapianti, CNT) released guidelines on donor management suggesting real-time reverse-transcription polymerase chain reaction (rRT-PCR) assays on nasopharyngeal swab (NPS) or bronchoalveolar lavage 24–48 h before organs retrieval, to identify and exclude SARS-CoV-2 positive donors. Conversely, no specific indications for recipients have been released so far. Although mortality data are not yet available in transplant recipients, outcome could be worse than in immunocompetent patients. For this reason, given for granted the negative status of the donor, our efforts should focus on assuring negativity of the recipient. In this document, we summarize our adopted strategies to mitigate the impact of the current pandemic based on our single-centre experience. Particularly, given CNT ensured indication about donor management, we will focus on the recipient’s list management and early postoperative treatment.