Journal Article

COVID-19 among heart transplant recipients in Germany: a multicenter survey

Hagl, Christian, Gummert, Jan F, Mücke, Victoria T, Christian, Schulze P, Raake, Philip W, Heyl, Stephan, Rudin, Pistulli, Barten, Markus J, Rivinius Rasmus, Heim, Christian, Knosalla Christoph, Warnecke Gregor, Rauschning Dominic, Katus Hugo A, Boeken Udo, Rieth, Andreas, Kreusser, Michael M, Provaznik Zdenek, Grinninger Carola, Schramm René, Kaya Ziya, Berchtold-Herz, Michael, Schoenrath Felix

2020

Overview

AimsHeart transplantation may represent a particular risk factor for severe coronavirus infectious disease 2019 (COVID-19) due to chronic immunosuppression and frequent comorbidities. We conducted a nation-wide survey of all heart transplant centers in Germany presenting the clinical characteristics of heart transplant recipients with COVID-19 during the first months of the pandemic in Germany.Methods and resultsA multicenter survey of all heart transplant centers in Germany evaluating the current status of COVID-19 among adult heart transplant recipients was performed. A total of 21 heart transplant patients with COVID-19 was reported to the transplant centers during the first months of the pandemic in Germany. Mean patient age was 58.6 ± 12.3 years and 81.0% were male. Comorbidities included arterial hypertension (71.4%), dyslipidemia (71.4%), diabetes mellitus (33.3%), chronic kidney failure requiring dialysis (28.6%) and chronic-obstructive lung disease/asthma (19.0%). Most patients received an immunosuppressive drug regimen consisting of a calcineurin inhibitor (71.4%), mycophenolate mofetil (85.7%) and steroids (71.4%). Eight of 21 patients (38.1%) displayed a severe course needing invasive mechanical ventilation. Those patients showed a high mortality (87.5%) which was associated with right ventricular dysfunction (62.5% vs. 7.7%; p = 0.014), arrhythmias (50.0% vs. none; p = 0.012), and thromboembolic events (50.0% vs. none; p = 0.012). Elevated high-sensitivity cardiac troponin T- and N-terminal prohormone of brain natriuretic peptide were significantly associated with the severe form of COVID-19 (p = 0.017 and p < 0.001, respectively).ConclusionSevere course of COVID-19 was frequent in heart transplanted patients. High mortality was associated with right ventricular dysfunction, arrhythmias, thromboembolic events, and markedly elevated cardiac biomarkers.

• Publisher: Springer Nature B.V
• Subject: Asthma / Biomarkers / Brain natriuretic peptide / Calcineurin / Calcineurin inhibitors / Calcium-binding protein / Cardiac arrhythmia / Coronaviruses / COVID-19 / Diabetes mellitus / Dialysis / Dyslipidemia / Heart transplantation / Heart transplants / Hypertension / Immunosuppression / Immunosuppressive agents / Infectious diseases / Lung diseases / Mechanical ventilation / Mortality / Mycophenolate mofetil / Mycophenolic acid / Obstructive lung disease / Pandemics / Renal failure / Risk analysis / Risk factors / Steroid hormones / Steroids / Thromboembolism / Transplantation / Troponin / Troponin T / Ventricle / Viral diseases / Vitamin E