Heart transplant

COVID-19 vaccination is safe, reduces infection risk in heart transplant recipients

New findings suggest that orthotopic heart transplant (OHT) patients who are infected with SARS-CoV-2 are at greater risk of serious infection and death compared to immunocompetent individuals, making vaccination against COVID-19 an important priority.

In fact, vaccination against COVID-19 was associated with fewer symptomatic COVID-19 infections, hospitalizations and deaths and no adverse events specific to heart transplantation.

“In light of more infectious COVID-19 variants and ongoing high transmission rates, COVID-19 vaccination for all OHT recipients is of paramount importance,” the study author wrote. Laura L. Peters, DNP, FNP, School of Medicine, University of Colorado.

Previous data report SARS-CoV-2 infection in heart transplant recipients is associated with a high case fatality rate ranging from 10% to 35% and a hospitalization rate ranging from 50% to 60 %. Moreover, among solid organ transplant recipients who received the mRNA vaccines, an antibody response was found in only 14% to 17% after the first dose and 48% to 51% after the second dose.

Although the study reported that the vaccine appeared safe, the current study aimed to assess the safety and efficacy of vaccination against COVID-19 in a large cohort of OHT recipients. A single-center retrospective case-control study of 482 adult OHT recipients was conducted from March 2020 to January 2022, according to study investigators.

They excluded a total of 46 OHT recipients who were infected with COVID-19 from March 2020 to January 2021 because they were infected before the vaccine series was available and completed. Then, starting in January 2021, the remaining 436 OHT recipients were divided into a vaccinated or unvaccinated group.

Primary outcomes were identified as the number of COVID-19 infections and COVID-19-related hospitalizations, intensive care unit (ICU) admissions, and deaths between vaccinated and unvaccinated adult recipients of the OHT.

Of the 436 patients included in the study, 106 patients became infected with COVID-19 at a median post-transplant time of 11.4 years. The data shows that the average age was 54, made up of 303 (69.5%) males and 133 (30.5%) females.

Of the 366 patients in the vaccinated cohort, there were 72 COVID-19 infections (19.7%) with 15 hospitalizations (4.1%), 4 ICU admissions (1.1%) and 3 deaths (0 .8%). Then, of the 70 patients in the unvaccinated cohort, there were 34 COVID-19 infections (48.6%), 10 hospitalizations (14.3%), 3 ICU admissions (4.3%) and 3 death (4.3%).

The vaccinated cohort of patients with OHT had a lower risk of COVID-19 infection (hazard ratio [RR], -.41; 95% CI, 0.30 – 0.56), hospitalization (RR, 0.29; 95% CI, 0.14 – 0.61) and death (RR, 0.19; 95% CI, 0 .05 – 0.82).

Peters and colleagues noted that there was no echocardiographic evidence of graft dysfunction, clinically significant rejection, or allosensitization 6 months after receiving the COVID-19 vaccine.

“Despite data suggesting that patients receiving solid organ transplant have a less robust antibody response to COVID-19 vaccines and the need for booster doses, this large observational study shows that COVID-19 vaccination is associated with fewer ‘symptomatic SARS-CoV-2 infections, hospitalizations and deaths,’ Peters concluded.

The study, “Association of COVID-19 Vaccination With Risk of COVID-19 Infection, Hospitalization, and Death in Heart Transplant Recipients,” was published in JAMA Cardiology.