Krannert Institute of Cardiology, Section of Advanced Heart Failure and Transplant Cardiology, Division of Cardiology, Indiana University School of Medicine, Indianapolis, USA.
, Indianapolis, USA.
Heart Fail Rev. 2022 Sep;27(5):1653-1663. doi: 10.1007/s10741-021-10181-y. Epub 2021 Oct 20.
The impact of SARS-CoV-2 infection on heart transplant recipients is unknown. Literature is limited to case reports and series. The purpose of this study is to identify the clinical features, outcomes, and immunosuppression strategies of heart transplant recipients with COVID-19 infection. A systematic review was conducted using the search term "Coronavirus" or COVID," "SARS-CoV-2," "cardiac transplantation," and "heart transplant." Case reports and retrospective studies were gathered by searching Medline/PubMed, Google Scholar, CINAHL, Cochrane CENTRAL, and Web of Science. Thirty-three articles were selected for review. We identified 74 cases of SARS-CoV-2 infection in heart transplant and heart-kidney transplant recipients. The mean age was 60.5 ± 15.8 years, and 82.4% were males with median time from transplant of 6.5 years. Commonest symptoms were fever, cough, and dyspnea, but new left ventricular (LV) dysfunction was rare. Leukocytosis, lymphopenia, elevated inflammatory markers, and bilateral ground-glass opacities were common. Mortality was high, with particularly poor survival in patients who required intensive care unit (ICU) admission and older patients. Immunosuppression involved discontinuation of antimetabolites and steroids. COVID-19 infection in heart transplant (HT) recipients presents similarly to the general population, but new onset of LV dysfunction is uncommon. Immunosuppression strategies include increase in corticosteroids and discontinuation of antimetabolites.
SARS-CoV-2 感染对心脏移植受者的影响尚不清楚。文献仅限于病例报告和系列研究。本研究旨在确定 COVID-19 感染的心脏移植受者的临床特征、结局和免疫抑制策略。使用搜索词“Coronavirus”或 COVID、“SARS-CoV-2”、“cardiac transplantation”和“heart transplant”进行了系统评价。通过搜索 Medline/PubMed、Google Scholar、CINAHL、Cochrane CENTRAL 和 Web of Science 收集了病例报告和回顾性研究。选择了 33 篇文章进行审查。我们确定了 74 例心脏移植和心脏-肾移植受者的 SARS-CoV-2 感染病例。平均年龄为 60.5±15.8 岁，82.4%为男性，中位移植时间为 6.5 年。最常见的症状是发热、咳嗽和呼吸困难，但新出现的左心室（LV）功能障碍很少见。白细胞增多、淋巴细胞减少、炎症标志物升高和双侧磨玻璃影很常见。死亡率很高，需要入住重症监护病房（ICU）和老年患者的患者生存率特别差。免疫抑制包括停用抗代谢物和类固醇。COVID-19 感染在心脏移植（HT）受者中的表现与普通人群相似，但新出现的 LV 功能障碍并不常见。免疫抑制策略包括增加皮质类固醇和停用抗代谢物。
