Schreiber Ariyon, Elango Kalaimani, Hong Kimberly, Ahsan Chowdhury
Department of Cardiology, University of Nevada, Las Vegas, 1800 W Charleston Blvd, Las Vegas, NV 89102, USA.
Department of Cardiology, University of California, San Diego Health, 200 West Arbor Drive, San Diego, CA 92103, USA.
Eur Heart J Case Rep. 2021 Jun 26;5(6):ytab217. doi: 10.1093/ehjcr/ytab217. eCollection 2021 Jun.
Heart transplant recipients represent a particularly vulnerable patient population to the novel coronavirus disease 2019 (COVID-19) due to chronic immunosuppression and high rates of comorbidities. Currently, data are limited and evidence to guide management of heart transplant recipients with COVID-19 is sparse. In this case report, we provide a summary of the current literature as well as an in-depth analysis of our clinical decision-making.
A 67-year-old female who underwent cardiac transplantation 1 year prior was found to have acute hypoxic respiratory failure due to COVID-19. Her immunosuppressant medications were modulated with discontinuation of mycophenolate and titration of tacrolimus troughs with a goal of 6-10 ng/dL. She was administered supportive treatment including convalescent plasma, remdesivir, and dexamethasone, in addition to antibiotic treatment that resulted in resolution of her symptoms within a matter of days despite her precarious disposition.
This case demonstrates that it can be safe and efficacious to modulate immunosuppressant medications in cardiac transplant recipients in accordance with recommendations made by the International Society of Heart and Lung Transplantation. This case additionally demonstrates that aspects of the current literature regarding the management of COVID-19 can be safely extrapolated to cardiac transplant recipients. Providing supportive care with dexamethasone, remdesivir, and convalescent plasma as indicated can be beneficial in cardiac transplant recipients; although, the current literature regarding convalescent plasma and remdesivir is conflicting.
由于慢性免疫抑制和高合并症发生率，心脏移植受者是新型冠状病毒病2019（COVID - 19）特别脆弱的患者群体。目前，数据有限，指导COVID - 19心脏移植受者管理的证据稀少。在本病例报告中，我们总结了当前文献，并对我们的临床决策进行了深入分析。
一名1年前接受心脏移植的67岁女性因COVID - 19出现急性低氧性呼吸衰竭。调整了她的免疫抑制药物，停用霉酚酸酯，并将他克莫司谷浓度滴定至目标值6 - 10 ng/dL。除抗生素治疗外，她还接受了包括恢复期血浆、瑞德西韦和地塞米松在内的支持性治疗，尽管病情危急，但数天内症状得到缓解。
本病例表明，根据国际心肺移植学会的建议调整心脏移植受者的免疫抑制药物可能是安全有效的。本病例还表明，当前关于COVID - 19管理的文献中的一些方面可以安全地外推至心脏移植受者。根据需要提供地塞米松、瑞德西韦和恢复期血浆的支持性护理对心脏移植受者可能有益；尽管目前关于恢复期血浆和瑞德西韦的文献存在矛盾。
