The 90-Day Risk of Hospitalization in Heart Transplant Recipients After COVID-19 Infection.

BACKGROUND

Heart transplant recipients are at a high-risk of complications from the coronavirus-2019 (COVID-19) infection. Heart transplant recipients are a special group of persistently immunosuppressed people, and COVID-19 may cause them to experience an unpredictable course of infection, with a risk of hospitalization occurring well beyond their initial infection period. The seriousness of COVID-19 disease in heart transplant recipients emphasizes how vital it is to refer patients promptly and early to specialized heart transplant centers.

METHODS

We retrospectively reviewed all heart transplant recipients at a single center between March 2019 and October 2021. All recipients with positive nasopharyngeal reverse transcriptase-polymerase chain reaction tests for COVID-19 were included in this study. After IRB approval, we obtained medical records and patient data from electronic medical records.

RESULTS

This study followed 126 heart transplant patients from March 2019 to October 2021 of which only 49 had COVID-19 infections. The median age at infection was 58 years (49-65), with 41% female. Race distribution was as follows: 59% Caucasian and 39% African American. The median time from transplant to infection was 384 days (237-677). All infected patients had a 50% dose reduction in mycophenolate mofetil per institutional protocol. The majority of symptoms were cough, fatigue, shortness of breath, and fever. Among all patients with COVID-19, 45 (92%) were vaccinated. Of those vaccinated, 27 (60%) patients received Pfizer initial and booster doses, whereas 18 (40%) received Moderna initial and booster doses. Twelve patients (24%) were hospitalized within 90 days of infection, with only two requiring ICU level of care. The median duration of hospitalization was 5 days (4-9). Of the hospitalized patients, 11 (92%) were discharged, and 1 (8%) died in the hospital. Three of the four unvaccinated patients were hospitalized, and one died while hospitalized. The remaining 37 patients were managed as outpatients.

CONCLUSION

Heart transplant recipients have an increased risk of contracting COVID-19 and developing severe symptoms due to multiple healthcare contacts, preexisting health conditions, and weakened immune systems. Our data highlight that most vaccinated patients do not require hospitalization within 90 days of infection, and those hospitalized have a high likelihood of survival without needing ICU care.