Heart transplant

SARS-CoV-2 infection in heart transplant recipients: a systematic review of the literature on clinical outcomes and immunosuppression strategies

This article was originally published here

Heart Fail Rev. 2021 October 20. doi: 10.1007 / s10741-021-10181-y. Online ahead of print.

ABSTRACT

The impact of SARS-CoV-2 infection on heart transplant recipients is unknown. The literature is limited to case reports and series. The aim of this study is to identify the clinical features, outcomes and immunosuppression strategies of heart transplant recipients infected with COVID-19. A systematic review was conducted using the search term “Coronavirus” or COVID “,” SARS-CoV-2 “,” heart transplant “and” heart transplant “. Case reports and retrospective studies were gathered by searching Medline / PubMed, Google Scholar, CINAHL, Cochrane CENTRAL and Web of Science. Thirty-three articles were selected for review. We identified 74 cases of SARS-CoV-2 infection in heart transplant recipients and heart-kidney transplant recipients. The mean age was 60.5 ± 15.8 years, and 82.4% were men with a median time since transplant of 6.5 years. The most common symptoms were fever, cough, and dyspnea, but new left ventricular (LV) dysfunction was rare. Leukocytosis, lymphopenia, elevated inflammatory markers, and bilateral ground glass opacities were common. Mortality was high, with particularly low survival in patients requiring intensive care unit (ICU) admission and older patients. Immunosuppression involved discontinuation of antimetabolites and steroids. COVID-19 infection in heart transplant (HT) recipients presents the same as in the general population, but the onset of new LV dysfunction is rare. Immunosuppression strategies include increasing corticosteroids and stopping antimetabolites.

PMID:34671872 | DO I:10.1007 / s10741-021-10181-y


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