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?:abstract
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BACKGROUND Available data on clinical presentation and mortality of coronavirus disease-2019 (COVID-19) in heart transplant (HT) recipients remain limited. METHODS We report a case series of laboratory-confirmed COVID-19 in 39 HT recipients from 3 French heart transplant centers (mean age 54.4±14.8 years; 66.7% males). RESULTS Hospital admission was required for 35 (89.7%) cases including 14/39 (35.9%) cases being admitted in intensive care unit. Immunosuppressive medications were reduced or discontinued in 74.4% of the patients. After a median follow-up of 54 (19 - 80) days, death and death or need for mechanical ventilation occurred in 25.6% and 33.3% of patients, respectively. Elevated C-reactive protein and lung involvement ≥50% on chest computed tomography (CT) at admission were associated with an increased risk of death or need for mechanical ventilation. Mortality rate from March to June in the entire 3-center HT recipient cohort was 56% higher in 2020 compared to the time-matched 2019 cohort (2% versus 1.28%, p=0.15). In a meta-analysis including 4 studies, preexisting diabetes mellitus (OR 3.60, 95% CI 1.43 - 9.06, I2 =0%, p=0.006) and chronic kidney disease stage III or higher (OR 3.79, 95% CI 1.39 - 10.31, I2 = 0%, p=0.009) were associated with increased mortality. CONCLUSION These findings highlight the aggressive clinical course of COVID-19 in HT recipients.
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