COVID-19 Case Fatality Doubled in Heart Transplant Patients
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The aim of this study was to assess the clinical course and outcomes of all heart transplant recipients affected by Coronavirus Disease 2019 (COVID-19) who were followed at the leading heart transplant centers of Northern Italy.

The worldwide SARS-CoV-2 pandemic has created unprecedented challenges for public health, demanding exceptional efforts for the successful management and treatment of affected patients. Heart transplant patients represent a unique cohort of chronically immunosuppressed subjects in which SARS-CoV-2 may stimulate an unpredictable clinical course of infection.

Since February 2020, we enrolled all 47 cases (79% male) in a first cohort of patients, with a mean age of 61.8 ± 14.5 years, who tested positive for SARS-CoV-2, out of 2,676 heart transplant recipients alive before the onset of the COVID-19 pandemic at 7 heart transplant centers in Northern Italy.

-- To date, 38 patients required hospitalization while 9 remained self-home quarantined and 14 died.

-- Compared to the general population, prevalence (18 vs. 7 cases per 1,000) and related case fatality rate (29.7% vs. 15.4%) in heart transplant recipients were doubled.

-- Univariable analysis showed older age (p = 0.002), diabetes mellitus, extracardiac arteriopathy, previous PCI, CAV score, lower GFR, and higher NYHA functional classes were all significantly associated with in-hospital mortality.

-- During the follow-up two patients died and a third patient has prolonged viral-shedding alternating positive and negative swabs.

-- Since July 1st, 2020, there were 6 new patients who tested positive for SARS-CoV-2, 5 patients asymptomatic were self-quarantined, while 1 is still hospitalized for pneumonia.

-- A standard therapy was maintained for all, except for the hospitalized patient.

Conclusively, the prevalence and mortality of SARS-CoV-2 should spur clinicians to immediately refer heart transplant recipients suspected as having SARS-CoV2 infection to centers specializing in the care of this vulnerable population.