Characteristics and outcomes of COVID-19 in heart transplantation recipients in the Netherlands

• Published in: Netherlands heart journal 2022-11, Vol.30 (11), p.519-525
• Main Authors: Muller, S. A., Manintveld, O. C., Szymanski, M. K., Damman, K., van der Meer, M. G., Caliskan, K., van Laake, L. W., Oerlemans, M. I. F. J.
• Format: Article
• Language: English
• Subjects: Body mass index; Cardiology; Cardiomyopathy; Chi-square test; Chronic obstructive pulmonary disease; Contact tracing; Coronaviruses; COVID-19 diagnostic tests; COVID-19 vaccines; Fever; Heart failure; Heart transplants; Hospitalization; Hypertension; Immunization; Intensive care; Ischemia; Laboratories; Medical Education; Medicine; Medicine & Public Health; Mortality; Original; Original Article; Patients; Risk factors; Serology; Severe acute respiratory syndrome coronavirus 2; Transplants & implants; Variables
• ISSN: 1568-5888; 1876-6250
• DOI: 10.1007/s12471-022-01720-9

Background Immunocompromised patients are at high risk of complicated severe acute respiratory coronavirus 2 infection. The aim of this retrospective study was to describe the characteristics and outcomes of heart transplantation (HTx) recipients with coronavirus disease 2019 (COVID-19) in the Netherlands. Methods HTx patients from one of the three HTx centres in the Netherlands with COVID-19 (proven by positive reverse-transcription polymerase chain reaction or serology test result) between February 2020 and June 2021 were included. The primary endpoint was all-cause mortality and the secondary endpoint was disease severity. Results COVID-19 was diagnosed in 54/665 HTx patients (8%), with a mean (± standard deviation (SD)) time after HTx of 11 ± 8 years. Mean (± SD) age was 53 ± 14 years and 39% were female. Immunosuppressive therapy dosage was reduced in 37% patients (20/54). Hospitalisation was required in 39% patients (21/54), and 13% patients (7/54) had severe COVID-19 (leading to intensive care unit (ICU) admission or death). In-hospital mortality was 14% (3/21), and all-cause mortality was 6%. Compared with patients with moderate COVID-19 (hospitalised without ICU indication), severe COVID-19 patients tended to be transplanted earlier and had a significantly higher mean (± SD) body mass index (26 ± 3 vs 30 ± 3 kg/m 2 , p  = 0.01). Myocardial infarction, cellular rejection and pulmonary embolism were observed once in three different HTx patients. Conclusion HTx patients were at increased risk of complicated COVID-19 with frequent hospitalisation, but the all-cause mortality was substantially lower than previously described (7–33%).