ACTION Study Group, INSERM UMRS_1166, Institut de Cardiologie, Pitié Salpêtrière, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Paris, France.
Département de Chirurgie Cardiaque, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Université de Paris, Paris, France.
Transpl Int. 2021 Apr;34(4):721-731. doi: 10.1111/tri.13837. Epub 2021 Mar 5.
Available data on clinical presentation and mortality of coronavirus disease-2019 (COVID-19) in heart transplant (HT) recipients remain limited. We report a case series of laboratory-confirmed COVID-19 in 39 HT recipients from 3 French heart transplant centres (mean age 54.4 ± 14.8 years; 66.7% males). Hospital admission was required for 35 (89.7%) cases including 14/39 (35.9%) cases being admitted in intensive care unit. Immunosuppressive medications were reduced or discontinued in 74.4% of the patients. After a median follow-up of 54 (19-80) days, death and death or need for mechanical ventilation occurred in 25.6% and 33.3% of patients, respectively. Elevated C-reactive protein and lung involvement ≥50% on chest computed tomography (CT) at admission were associated with an increased risk of death or need for mechanical ventilation. Mortality rate from March to June in the entire 3-centre HT recipient cohort was 56% higher in 2020 compared to the time-matched 2019 cohort (2% vs. 1.28%, P = 0.15). In a meta-analysis including 4 studies, pre-existing diabetes mellitus (OR 3.60, 95% CI 1.43-9.06, I = 0%, P = 0.006) and chronic kidney disease stage III or higher (OR 3.79, 95% CI 1.39-10.31, I = 0%, P = 0.009) were associated with increased mortality. These findings highlight the aggressive clinical course of COVID-19 in HT recipients.
关于心脏移植（HT）受者中 2019 年冠状病毒病（COVID-19）的临床表现和死亡率的现有数据仍然有限。我们报告了来自法国 3 个心脏移植中心的 39 例经实验室确诊的 COVID-19 的病例系列，这些患者均为 HT 受者（平均年龄 54.4±14.8 岁；66.7%为男性）。35 例（89.7%）需要住院治疗，包括 14/39（35.9%）例患者需要入住重症监护病房。74.4%的患者减少或停用了免疫抑制药物。中位随访 54（19-80）天后，分别有 25.6%和 33.3%的患者死亡和死亡或需要机械通气。入院时 C 反应蛋白升高和胸部 CT 显示肺受累≥50%与死亡或需要机械通气的风险增加相关。在整个 3 个中心的 HT 受者队列中，2020 年 3 月至 6 月的死亡率比时间匹配的 2019 年队列高 56%（2%比 1.28%，P=0.15）。在一项包含 4 项研究的荟萃分析中，预先存在的糖尿病（OR 3.60，95%CI 1.43-9.06，I=0%，P=0.006）和慢性肾脏病 3 期或更高（OR 3.79，95%CI 1.39-10.31，I=0%，P=0.009）与死亡率增加相关。这些发现强调了 COVID-19 在 HT 受者中具有侵袭性的临床病程。
