Heart transplant

Vaccination reduces SARS-CoV-2 infection and mortality risk in heart transplant recipients

April 27, 2022

2 minute read

Source/Disclosures

Disclosures:
The authors report no relevant financial information.


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According to a brief report published in JAMA Cardiology.

“The FDA issued an emergency use authorization for a messenger RNA (mRNA) vaccine against COVID-19 on December 11, 2020,” Laura L. Peters, DNP, FNP, an advanced heart failure and heart transplant nurse practitioner and assistant professor of medicine-cardiology at the University of Colorado Hospital, and her colleagues wrote. “Transplant recipients were excluded from initial safety studies of COVID-19 vaccines, and there were concerns that transplant recipients may have suboptimal immunogenicity due to immunosuppression.”

Graphical representation of the data presented in the article

Data are from Peters LL, et al. JAMA-cardiol. 2022;doi:10.1001/jamacardio.2022.0670.

Previous studies in JAMA and Jhe Journal of Heart and Lung Transplantation reported that approximately 14% to 17% of solid organ transplant recipients who received COVID-19 mRNA vaccines had an antibody response after the first dose, and 48% to 51% had a antibody response after the second dose.

“Although the study reported that COVID-19 vaccines appear to be safe in transplant recipients, the implications of only a partial antibody response to vaccination toward protection against COVID-19-related morbidity and mortality remain. unknown,” the researchers wrote. “Therefore, we sought to assess the safety and efficacy of vaccination against COVID-19 in a large cohort of orthotopic heart transplant recipients.”

The researchers conducted the present case-control study using data from a single US center. The analysis included 436 adult orthotopic heart transplant recipients (mean age, 54 years; 70% male) who were followed from January 15, 2021 to January 31, 2022.

The primary outcome was COVID-19, related hospitalizations, ICU admissions, and deaths in vaccinated compared to unvaccinated heart transplant recipients.

A total of 366 heart transplant recipients were vaccinated, of which 19.7% contracted COVID-19, 4.1% were hospitalized, 1.1% were admitted to intensive care and 0.8% died.

Among the 70 unvaccinated heart transplant recipients, 48.6% contracted COVID-19, 14.3% were hospitalized, 4.3% were admitted to intensive care and 4.3% died.

Researchers reported that vaccination against COVID-19 in heart transplant patients was associated with a lower risk of infection (RR=0.41; 95% CI, 0.3-0.56) , COVID-19 hospitalization (RR=0.29; 95% CI, 0.14-0.61) and death (RR=0.19; 95% CI, 0.05-0, 82) compared to non-vaccination.

Six months after vaccination, researchers observed no changes in mean left ventricular ejection fraction, LV wall thickness, and B-type natriuretic peptide levels.

Moreover, among patients who experienced COVID-19 infection even after vaccination, mean LVEF, LV wall thickness, and BNP levels remained unchanged from baseline measurements before vaccination.

There were no cases of rejection or allosensitization, according to the researchers.

“Despite theoretical safety concerns for vaccination leading to immune activation and subsequent organ rejection or myocarditis, we found no evidence of allograft dysfunction, clinically significant rejection or allosensitization in this large cohort of vaccinated patients with orthotopic heart transplantation,” the researchers wrote. “The combination of these results supports the recommendations of the professional society and individual transplant centers that orthotopic heart transplant recipients receive COVID-19 vaccines. »

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