• J. Heart Lung Transplant. · Oct 2020

    Multicenter Study Comparative Study

    A case series of novel coronavirus infection in heart transplantation from 2 centers in the pandemic area in the North of Italy.

    • Attilio Iacovoni, Massimo Boffini, Stefano Pidello, Erika Simonato, Cristina Barbero, Roberta Sebastiani, Claudia Vittori, Alessandra Fontana, Amedeo Terzi, Gaetano Maria De Ferrari, and Mauro Rinaldi.
    • Cardiology Division, Cardiovascular Department, Heart Transplant Center, ASST Papa Giovanni XXIII Hospital of Bergamo, Bergamo, Italy.
    • J. Heart Lung Transplant. 2020 Oct 1; 39 (10): 1081-1088.

    BackgroundLittle is known about the coronavirus SARS-CoV-2 disease (COVID-19) in solid organ transplanted patients. We here report a series of heart transplanted patients with COVID-19 from two centers of Italy.MethodsAll heart transplanted patients of Transplant Centers of Bergamo and Torino with a microbiologically confirmed SARS-CoV-2 infection were enrolled. Data collection included clinical presentation, laboratory and radiological findings, treatment and outcome. Follow-up was performed by visit or phone.ResultsFrom February to March 2020 twenty-six heart transplanted patients (age 62±12 years; 77% males; time from transplant 10±10 years; 69% with comorbidities) had a microbiologically confirmed COVID-19. The most frequent symptom was fever, followed by cough. Seventeen patients had a pneumonia, 8 of them severe pneumonia. Seven patients died (27%) and 17 (65%) were hospitalized. Discontinuation of immunosuppression was associated with death (71 vs 21%, p=0.02). Conversely, all patients receiving steroids survived (p<0.001). Patients who received heart transplantation during COVID-19 outbreak survived and no acute graft rejection occurred. Patients who died were older than survivors, had a longer time from transplant and a worse clinical presentation at diagnosis. The current regimen enabled the prolonged survival and function of orthotopic cardiac xenografts in altogether 6 of 8 baboons, of which 4 were now added. These results exceed the threshold set by the Advisory Board of the International Society for Heart and Lung Transplantation.ConclusionsCOVID-19 has a significant impact on long term heart transplanted patients. Conversely, SARS-CoV-2 infection seems to have a limited influence on more recent transplants. Our experience may suggest that heart transplantation programs can be maintained even during the pandemic phase if specific and tailored paths to prevent and to limit virus transmission are provided.Copyright © 2020 International Society for Heart and Lung Transplantation. Published by Elsevier Inc. All rights reserved.

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