Heart and Vascular Institute, Henry Ford Hospital, Detroit, MI, USA.
Clin Transplant. 2020 Dec;34(12):e14091. doi: 10.1111/ctr.14091. Epub 2020 Oct 1.
A chronic immunosuppressed state as in solid organ transplant recipients is a reported risk factor for the novel 2019 coronavirus infection. Patients with a history of orthotopic heart transplant (OHT) at a tertiary care transplant center in Detroit, Michigan were retrospectively reviewed from March until May 2020. Clinical parameters and outcomes of 5 OHT recipients and one combined heart-lung recipient with confirmed SARS-CoV-2 were obtained. The cohort was predominately African American males with median age of 59 years (interquartile range, 48.25-73.25). All patients were classified as having mild-moderate disease; none required intubation or ICU admission with no deaths. The most common presenting symptoms were fever and shortness of breath 83% (n = 5), followed by cough and chills 67% (n = 4). All admitted patients (n = 5) received hydroxychloroquine and 3 received high-dose steroids. Antimetabolites were held for 2 patients (33.3%). The calcineurin inhibitor trough goal was decreased in only 1 patient; 3 other patients, without change in goal, required calcineurin inhibitor dosage reduction. Two patients requiring readmission presented 7 and 23 days after initial symptoms onset. In conclusion, our experience with OHT patients infected by the SARS-CoV-2 virus did not have an elevated risk of severe infection. Impact of modifying immunosuppression remains unclear.
慢性免疫抑制状态,如实体器官移植受者,是新型 2019 冠状病毒感染的报告危险因素。回顾性分析了密歇根州底特律一家三级保健移植中心的接受过原位心脏移植(OHT)的患者。从 2020 年 3 月至 5 月,获得了 5 例 OHT 受者和 1 例合并心肺受者的临床参数和结局,该受者确诊为 SARS-CoV-2。该队列主要为非洲裔美国男性,中位年龄为 59 岁(四分位距,48.25-73.25)。所有患者均被归类为轻度-中度疾病;无一例需要插管或 ICU 入院,无死亡病例。最常见的首发症状是发热和呼吸急促 83%(n=5),其次是咳嗽和寒战 67%(n=4)。所有住院患者(n=5)均接受羟氯喹治疗,3 例接受高剂量类固醇治疗。2 例(33.3%)患者停用了代谢抑制剂。仅 1 例患者降低了钙调神经磷酸酶抑制剂谷值目标;3 例其他患者目标未改变,但需要减少钙调神经磷酸酶抑制剂剂量。2 例需要再次入院的患者在初次症状出现后 7 天和 23 天。总之,我们对感染 SARS-CoV-2 病毒的 OHT 患者的经验表明,他们感染严重感染的风险并未增加。免疫抑制调节的影响仍不清楚。