Division of Heart Failure and Transplant, Mayo Clinic in Florida, Jacksonville, FL, USA.
Division of Heart Failure and Transplant, Mayo Clinic in Florida, Jacksonville, FL, USA.
Transplant Proc. 2024 Jul-Aug;56(6):1496-1501. doi: 10.1016/j.transproceed.2024.05.024. Epub 2024 Aug 3.
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.
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.
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.
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.
心脏移植受者感染 2019 年冠状病毒（COVID-19）的并发症风险较高。心脏移植受者是一组持续免疫抑制的特殊人群，COVID-19 可能使他们经历不可预测的感染过程，住院风险超出初始感染期。COVID-19 疾病在心脏移植受者中的严重性强调了及时将患者转介至专门的心脏移植中心的重要性。
我们回顾性分析了 2019 年 3 月至 2021 年 10 月期间在一家中心进行的所有心脏移植受者。本研究纳入所有鼻咽部逆转录-聚合酶链反应检测 COVID-19 阳性的心脏移植受者。在获得机构审查委员会批准后，我们从电子病历中获取了病历和患者数据。
本研究纳入了 2019 年 3 月至 2021 年 10 月期间的 126 例心脏移植患者，其中只有 49 例发生 COVID-19 感染。感染时的中位年龄为 58 岁（49-65 岁），女性占 41%。种族分布如下：59%为白种人，39%为非裔美国人。从移植到感染的中位时间为 384 天（237-677）。所有感染患者均按照机构方案将吗替麦考酚酯剂量减少 50%。大多数症状为咳嗽、疲劳、呼吸急促和发热。所有 COVID-19 患者中，45 例（92%）已接种疫苗。在接种疫苗的患者中，27 例（60%）接受了辉瑞初始和加强剂量，18 例（40%）接受了莫德纳初始和加强剂量。12 例（24%）患者在感染后 90 天内住院，其中仅 2 例需要 ICU 级别的护理。住院中位时间为 5 天（4-9）。住院患者中，11 例（92%）出院，1 例（8%）住院期间死亡。4 例未接种疫苗的患者中有 3 例住院，其中 1 例住院死亡。其余 37 例患者作为门诊患者进行管理。
心脏移植受者由于多次医疗接触、既往健康状况和免疫系统减弱，感染 COVID-19 和出现严重症状的风险增加。我们的数据表明，大多数接种疫苗的患者在感染后 90 天内不需要住院，住院患者无需 ICU 护理即可存活的可能性很高。
