Division of Cardiology, Department of Internal Medicine, University of California San Diego Sulpizio Cardiovascular Center, La Jolla, California, USA.
Division of Infectious Diseases and Global Public Health, Department of Internal Medicine, University of California San Diego Sulpizio Cardiovascular Center, La Jolla, California, USA.
Clin Transplant. 2022 Jan;36(1):e14443. doi: 10.1111/ctr.14443. Epub 2021 Dec 13.
Immunosuppressed heart transplant (HT) recipients are thought to be at higher risk of infection and mortality from SARS-CoV-2 infection coronavirus disease 2019 (COVID-19); however, evidence guiding management of HT patients are limited. Retrospective search of electronic health records from February 2020 to February 2021, identified 28 HT recipients out of 400 followed by UC San Diego who tested positive for SARS-CoV-2. Patient demographics, COVID-19 directed therapies, hospital course and outcomes were compared to control HT recipients who tested negative for SARS-CoV-2 during the same period (n = 80). Among 28 HT recipients who tested positive for SARS-CoV-2, 15 were admitted to the hospital and 13 were monitored closely as outpatients. Among inpatients, five developed severe illness and two died (7% mortality). Nine patients were treated with remdesivir, and four received dexamethasone and remdesivir. Two outpatients received neutralizing monoclonal antibody therapy and one outpatient received dexamethasone for persistent dyspnea. Immunosuppressed HT recipients, especially Hispanic patients and patients with higher body mass index, were at greater risk of infection and mortality from COVID-19 than the general population. Use of remdesivir and dexamethasone may have improved outcomes in our HT recipients compared to HT recipients at other centers.
免疫抑制的心脏移植（HT）受者被认为感染 SARS-CoV-2 冠状病毒病 2019（COVID-19）的风险更高，并且死亡率也更高；然而，指导 HT 患者管理的证据有限。从 2020 年 2 月至 2021 年 2 月，对加利福尼亚大学圣地亚哥分校 400 名接受随访的 HT 受者中的 28 名进行了电子病历的回顾性搜索，这些受者的 SARS-CoV-2 检测结果呈阳性。将他们的患者人口统计学、COVID-19 定向治疗、住院过程和结果与同期 SARS-CoV-2 检测结果为阴性的 80 名对照 HT 受者进行比较。在 28 名 SARS-CoV-2 检测结果呈阳性的 HT 受者中，有 15 名住院，13 名作为门诊患者接受密切监测。在住院患者中，有 5 人病情严重，2 人死亡（7%的死亡率）。有 9 名患者接受了瑞德西韦治疗，4 名患者接受了地塞米松和瑞德西韦治疗。2 名门诊患者接受了中和单克隆抗体治疗，1 名门诊患者因持续性呼吸困难接受了地塞米松治疗。与一般人群相比，免疫抑制的 HT 受者，特别是西班牙裔患者和体重指数较高的患者，感染 COVID-19 和死亡率更高。与其他中心的 HT 受者相比，我们的 HT 受者使用瑞德西韦和地塞米松可能改善了预后。
