• Tomaso Bottio, Lorenzo Bagozzi, Alessandro Fiocco, Matteo Nadali, Raphael Caraffa, Olimpia Bifulco, Matteo Ponzoni, Carlo Maria Lombardi, Marco Metra, Claudio Francesco Russo, Maria Frigerio, Gabriella Masciocco, Luciano Potena, Antonio Loforte, Davide Pacini, Giuseppe Faggian, Francesco Onorati, Sandro Sponga, Ugolino Livi, Attilio Iacovoni, Amedeo Terzi, Michele Senni, Mauro Rinaldi, Massimo Boffini, Matteo Marro, Vjola Jorgji, Massimiliano Carrozzini, and Gino Gerosa.
• Cardiac Surgery Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy. Electronic address: tbottio@gmail.com.
• JACC Heart Fail. 2021 Jan 1; 9 (1): 52-61.

ObjectivesThe 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.BackgroundThe worldwide severe acute respiratory syndrome-coronavirus-2 (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.MethodsSince 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.ResultsTo 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 (p = 0.040), extracardiac arteriopathy (p = 0.040), previous PCI (p = 0.040), CAV score (p = 0.039), lower GFR (p = 0.004), and higher NYHA functional classes (p = 0.023) 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, we had 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.ConclusionsThe 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.Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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