Characteristics and Outcomes of Heart Transplant Recipients with Coronavirus-19 Disease in A High-Volume Transplant Center.

BACKGROUND: Heart transplant (HT) recipients may be at higher risk of acquiring SARS-CoV-2 infection and developing critical illness. The aim of this study is to describe characteristics and outcomes of HT recipients infected by SARS-COV-2, from a high-volume transplant center. METHODS: We have described data of all adult HT recipients with confirmed COVID-19 by RT-PCR in nasopharyngeal samples from April 5th,2020 to January 5th, 2021. Outcomes and follow-up were recorded until February 5th, 2021. RESULTS: Forty patients were included. Twenty-four patients (60%) were men; the median age was 53 (40-60) years old; median HT time was 34 months and median follow-up time 162 days. The majority needed hospitalization (83%). Immunosuppressive therapy was reduced/withdrawn in the majority of patients, except from steroids, which were maintained. Seventeen patients (42.5%) were classified as having severe disease according to the ordinal scale developed by the WHO Committee. They tended to have lower absolute lymphocyte count (p<0.001) during follow-up when compared to patients with mild disease. Thirty-day mortality was 12.5%. However, a longer follow-up revealed increased later mortality (27.5%), with median time to death around 35 days. Bacterial nosocomial infections were a leading cause of death. Cardiac allograft rejection (10%) and ventricular dysfunction (12.5%) were also not negligible. CONCLUSIONS: Major findings of this study corroborate other cohorts' results, but it also reports significant rate of later events, suggesting that a strict mid-term surveillance is advisable to HT recipients with COVID-19.