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 = 0.002), diabetes mellitus (p = 0.040), extracardiac arteriopathy (p = 0.040), previous PCI (p = 0.040), CAV score (p = 0.039), lower GFR (p = 0.004), and higher NYHA functional classes (p = 0.023) were all significantly associated with in-hospital mortality. During the follow-up 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.

中文翻译：

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心脏移植接受者中的 COVID-19

目标

本研究的目的是评估在意大利北部主要心脏移植中心接受随访的所有受 2019 冠状病毒病 (COVID-19) 影响的心脏移植接受者的临床过程和结果。

背景

全球严重急性呼吸系统综合症冠状病毒 2 (SARS-CoV-2) 大流行给公共卫生带来了前所未有的挑战，需要付出巨大努力才能成功管理和治疗受影响的患者。心脏移植患者代表了一组独特的慢性免疫抑制受试者，其中 SARS-CoV-2 可能会刺激不可预测的临床感染过程。

方法

自 2020 年 2 月以来，我们在第一批患者中纳入了所有 47 例患者（79% 为男性），平均年龄为 61.8 ± 14.5 岁，SARS-CoV-2 检测呈阳性，在 2,676 名心脏移植接受者中存活下来意大利北部 7 个心脏移植中心爆发 COVID-19 大流行。

结果

迄今为止，有 38 名患者需要住院治疗，9 名患者仍在家中隔离，14 名患者死亡。与一般人群相比，心脏移植受者的患病率（每 1,000 人中有 18 例对 7 例）和相关病死率（29.7% 对 15.4%）翻了一番。单变量分析显示年龄较大 (p = 0.002)、糖尿病 (p = 0.040)、心外动脉病变 (p = 0.040)、既往 PCI (p = 0.040)、CAV 评分 (p = 0.039)、较低的 GFR (p = 0.004)和更高的 NYHA 功能等级 (p = 0.023) 均与院内死亡率显着相关。在随访期间，两名患者死亡，第三名患者病毒脱落时间延长，阳性和阴性拭子交替出现。自 2020 年 7 月 1 日以来，我们有 6 名新患者 SARS-CoV-2 检测呈阳性，5 名无症状患者自我隔离，而1人仍因肺炎住院。除住院患者外，所有人都保持标准治疗。

结论

SARS-CoV-2 的流行率和死亡率应促使临床医生立即将疑似感染 SARS-CoV2 的心脏移植受者转诊至专门护理这一弱势人群的中心。