Michael V Genuardi1, Noah Moss2, Samer S Najjar3, Brian A Houston4, Supriya Shore5, Esther Vorovich6, Pavan Atluri7, Maria Molina8, Susan Chambers8, Tiffany Sharkoski8, Eileen Hsich9, Jerry D Estep9, Anjali T Owens8, Kevin M Alexander10, Sunit-Preet Chaudhry11, Rafael Garcia-Cortes11, Ezequiel Molina3, Maria Rodrigo3, MDc Joyce Wald8, Kenneth B Margulies8, Thomas C Hanff8, Ross Zimmer8, Arman Kilic12, Rhondalyn Mclean8, Himabindu Vidula13, Katherine Dodd6, Emily A Blumberg14, Jeremy A Mazurek8, Lee R Goldberg15, Jesus Alvarez-Garcia2, Donna Mancini2, Jeffrey J Teuteberg10, Ryan J Tedford4, Edo Y Birati16. 1. Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: Michael.Genuardi@pennmidicine.upenn.edu. 2. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York. 3. MedStar Washington Hospital Center, Washington, DC. 4. Medical University of South Carolina, Charleston, SC. 5. Cardiovascular Division, University of Michigan, Ann Arbor, MI. 6. Division of Cardiology, Northwestern University, Chicago, IL. 7. Department of Cardiothoracic Surgery, University of Pennsylvania, Pennsylvania. 8. Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. 9. Heart and Vascular Institute at the Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH. 10. Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA. 11. St. Vincent Medical Group, St. Vincent Heart Center, Indianapolis, IN. 12. Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania. 13. Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York. 14. Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania. 15. Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania. 16. Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular division, Poriya Medical Center, Bar Ilan University, Israel.
Abstract
BACKGROUND: COVID-19 continues to inflict significant morbidity and mortality, particularly on patients with preexisting health conditions. The clinical course, outcomes, and significance of immunosuppression regimen in heart transplant recipients with COVID-19 remains unclear. METHODS: We included the first 99 heart transplant recipients at participating centers with COVID-19 and followed patients until resolution. We collected baseline information, symptoms, laboratory studies, vital signs, and outcomes for included patients. The association of immunosuppression regimens at baseline with severe disease were compared using logistic regression, adjusting for age and time since transplant. RESULTS: The median age was 60 years, 25% were female, and 44% were white. The median time post-transplant to infection was 5.6 years. Overall, 15% died, 64% required hospital admission, and 7% remained asymptomatic. During the course of illness, only 57% of patients had a fever, and gastrointestinal symptoms were common. Tachypnea, oxygen requirement, elevated creatinine and inflammatory markers were predictive of severe course. Age ≥ 60 was associated with higher risk of death and the use of the combination of calcineurin inhibitor, antimetabolite, and prednisone was associated with more severe disease compared to the combination of calcineurin inhibitor and antimetabolite alone (adjusted OR = 7.3, 95% CI 1.8-36.2). Among hospitalized patients, 30% were treated for secondary infection, acute kidney injury was common and 17% required new renal replacement therapy. CONCLUSIONS: We present the largest study to date of heart transplant patients with COVID-19 showing common atypical presentations and a high case fatality rate of 24% among hospitalized patients and 16% among symptomatic patients.
BACKGROUND:COVID-19 continues to inflict significant morbidity and mortality, particularly on patients with preexisting health conditions. The clinical course, outcomes, and significance of immunosuppression regimen in heart transplant recipients with COVID-19 remains unclear. METHODS: We included the first 99 heart transplant recipients at participating centers with COVID-19 and followed patients until resolution. We collected baseline information, symptoms, laboratory studies, vital signs, and outcomes for included patients. The association of immunosuppression regimens at baseline with severe disease were compared using logistic regression, adjusting for age and time since transplant. RESULTS: The median age was 60 years, 25% were female, and 44% were white. The median time post-transplant to infection was 5.6 years. Overall, 15% died, 64% required hospital admission, and 7% remained asymptomatic. During the course of illness, only 57% of patients had a fever, and gastrointestinal symptoms were common. Tachypnea, oxygen requirement, elevated creatinine and inflammatory markers were predictive of severe course. Age ≥ 60 was associated with higher risk of death and the use of the combination of calcineurin inhibitor, antimetabolite, and prednisone was associated with more severe disease compared to the combination of calcineurin inhibitor and antimetabolite alone (adjusted OR = 7.3, 95% CI 1.8-36.2). Among hospitalized patients, 30% were treated for secondary infection, acute kidney injury was common and 17% required new renal replacement therapy. CONCLUSIONS: We present the largest study to date of heart transplant patients with COVID-19 showing common atypical presentations and a high case fatality rate of 24% among hospitalized patients and 16% among symptomatic patients.
Authors: Fernando Luis Scolari; Laura Caroline Tavares Hastenteufel; Lídia Einsfeld; Julia Bueno; Letícia Orlandin; Nadine Clausell; Lívia Adams Goldraich Journal: Front Med (Lausanne) Date: 2022-02-09
Authors: Katalin Martits-Chalangari; Cedric W Spak; Medhat Askar; Aaron Killian; Tammy L Fisher; Ercem Atillasoy; William L Marshall; David McNeel; Michael D Miller; Susan K Mathai; Robert L Gottlieb Journal: Am J Transplant Date: 2021-12-27 Impact factor: 9.369
Authors: S A Muller; O C Manintveld; M K Szymanski; K Damman; M G van der Meer; K Caliskan; L W van Laake; M I F J Oerlemans Journal: Neth Heart J Date: 2022-09-08 Impact factor: 2.854
Authors: Richard Tanner; Neasa Starr; Carlos Nicolas Perez-Garcia; Grace Chan; Eimear Dempsey; Emma Heffernan; Breda Lynch; Margaret M Hannan; Emer Joyce Journal: Transpl Infect Dis Date: 2022-08-18
Authors: Jason M Duran; Masihullah Barat; Andrew Y Lin; Kevin R King; Barry Greenberg; Eric D Adler; Saima Aslam Journal: Clin Transplant Date: 2021-12-13 Impact factor: 3.456