In a retrospective case report series published in JAMA Cardiology, researchers found that heart transplant (HT) recipients with COVID-19 are at high risk for severe complications. The researchers, led by Nir Uriel, MD, MSc, Director of Advanced Heart failure and Cardiac Transplantation at NewYork-Presbyterian, discuss implications for the management of SARS-COV2 given the need for immunosuppression in this patient population.
Patient Symptoms and Characteristics
Researchers identified 28 cases out of a cohort of 804 HT recipients at NewYork-Presbyterian/Columbia who presented for acute care for COVID-19 between March 1, 2020, and April 24, 2020. The majority of cases presented with cough or dyspnea (91%) and fever (83%), and almost half had gastrointestinal symptoms (48%).
The cohort had a high rate of comorbid conditions including hypertension (71%), diabetes mellitus (61%), cardiac allograft vasculopathy (57%), chronic kidney disease stage 4 or worse (36%), and obesity (25%). The majority were male (79%), had a median age of 64 years, and a median of 8.6 years had transpired since patients were transplanted.
Treatment and Outcomes
The majority of patients were hospitalized (n=22/28; 79%) and received supplemental oxygen. Treatment administered included hydroxychloroquine, high-dose corticosteroids, and interleukin 6 receptor antagonists. Immunosuppression regimens were reduced in most patients following a diagnosis of COVID-19, but overt graft rejection was not observed during the study period.
A total of 7 patients required intubation (2 at NewYork-Presbyterian and 5 at outside hospitals) and ultimately died; 11 were discharged from the hospital, and 4 remained hospitalized at the end of the study period. All study participants exhibited elevated inflammatory biomarkers and most had evidence of myocardial injury. The authors reported a case fatality rate of 25% among HT patients infected with COVID-19.
Study Implications
Dr. Uriel and colleagues suggest close monitoring at a transplant center to reduce the risk for severe complications related to SARS-COV2. Heart transplant recipients who are chronically immunosuppressed are a vulnerable patient population and may have unique risk- and protective-factors for SARS-COV2. Future studies are needed to elucidate the relationship between immunosuppression and a greater risk for infection with SARS-COV2 versus the potential protective effects it may play during the cytokine storm.
Why NewYork-Presbyterian?
As the highest-volume center in the United States, NewYork-Presbyterian’s Heart Failure and Transplant Program provides advanced, comprehensive cardiac care for patients with all types of heart failure. With more than 30 years of experience, our team performs more than 80 transplants per year with very high survival outcomes.
This high level of experience and expertise allows our physician scientists to engage in robust research protocols, helping to offer patients who may have no other option access to cutting-edge treatments and procedures. Our research studies also help to highlight unmet needs and improve patient outcomes.
In light of SARS-COV2, the Heart Failure and Transplant Center at NewYork-Presbyterian is taking special precautions. Currently, we are performing transplant procedures and providing non-emergency telemedicine visits. To refer a patient, please call (212) 305-7600 or request an appointment online. We are committed to sharing the lessons we’ve learned from the pandemic in order to provide optimal care for patients.