The George Washington University School of Medicine and Health Sciences, Washington DC, USA.
Cedars-Sinai Smidt Heart Institute, Los Angeles, California, USA.
Clin Transplant. 2022 Jul;36(7):e14697. doi: 10.1111/ctr.14697. Epub 2022 May 20.
The COVID-19 pandemic initially brought forth considerable challenges to the field of heart transplantation. To prevent the spread of the virus and protect immunocompromised recipients, our center made the following modifications to post-transplant outpatient management: eliminating early coronary angiograms, video visits for postoperative months 7, 9, and 11, and home blood draws for immunosuppression adjustments. To assess if these changes have impacted patient outcomes, the current study examines 1-year outcomes for patients transplanted during the pandemic. Between March and September 2020, we assessed 50 heart transplant patients transplanted during the pandemic. These patients were compared to patients who were transplanted during the same months between 2011 and 2019 (n = 482). Endpoints included subsequent 1-year survival, freedom from cardiac allograft vasculopathy, any-treated rejection, acute cellular rejection, antibody-mediated rejection, nonfatal major adverse cardiac events (NF-MACE), and hospital and ICU length of stay. Patients transplanted during the pandemic had similar 1-year endpoints compared to those of patients transplanted from years prior apart from 1-year freedom from NF-MACE which was significantly higher for patients transplanted during the pandemic. Despite necessary changes being made to outpatient management of heart transplant recipients, heart transplantation continues to be safe and effective with similar 1-year outcomes to years prior.
COVID-19 大流行最初给心脏移植领域带来了相当大的挑战。为了防止病毒传播和保护免疫功能低下的受者,我们中心对移植后门诊管理进行了以下修改:取消早期冠状动脉造影,术后第 7、9 和 11 个月进行视频访问,以及在家中进行免疫抑制调整的血液采集。为了评估这些变化是否影响患者的结局,本研究检查了大流行期间接受心脏移植的患者的 1 年结局。在 2020 年 3 月至 9 月期间,我们评估了 50 例大流行期间接受心脏移植的患者。将这些患者与 2011 年至 2019 年同期接受移植的患者(n=482)进行比较。终点包括随后的 1 年生存率、无心脏移植血管病、任何治疗的排斥反应、急性细胞排斥反应、抗体介导的排斥反应、非致命性主要不良心脏事件(NF-MACE)以及住院和 ICU 住院时间。与之前接受移植的患者相比,大流行期间接受移植的患者具有相似的 1 年结局,除了大流行期间接受移植的患者 1 年 NF-MACE 无事件生存率显著更高。尽管对心脏移植受者的门诊管理进行了必要的更改,但心脏移植仍然是安全有效的,与之前几年的 1 年结局相似。