Characteristics and Outcomes of Recipients of Heart Transplant With Coronavirus Disease 2019.
Identifieur interne : 001709 ( Main/Corpus ); précédent : 001708; suivant : 001710Characteristics and Outcomes of Recipients of Heart Transplant With Coronavirus Disease 2019.
Auteurs : Farhana Latif ; Maryjane A. Farr ; Kevin J. Clerkin ; Marlena V. Habal ; Koji Takeda ; Yoshifumi Naka ; Susan Restaino ; Gabriel Sayer ; Nir UrielSource :
- JAMA cardiology [ 2380-6591 ] ; 2020.
English descriptors
- KwdEn :
- Aged (MeSH), Biomarkers (blood), C-Reactive Protein (analysis), COVID-19 (mortality), COVID-19 (therapy), Comorbidity (MeSH), Female (MeSH), Glucocorticoids (therapeutic use), Heart Transplantation (MeSH), Hospitalization (statistics & numerical data), Humans (MeSH), Hydroxychloroquine (therapeutic use), Immunosuppressive Agents (administration & dosage), Interleukin-6 (blood), Male (MeSH), Middle Aged (MeSH), New York City (epidemiology), Receptors, Interleukin-6 (antagonists & inhibitors), Respiration, Artificial (statistics & numerical data), Retrospective Studies (MeSH), Transplant Recipients (MeSH), Troponin T (blood).
- MESH :
- chemical , administration & dosage : Immunosuppressive Agents.
- chemical , analysis : C-Reactive Protein.
- chemical , antagonists & inhibitors : Receptors, Interleukin-6.
- chemical , blood : Biomarkers, Interleukin-6, Troponin T.
- geographic , epidemiology : New York City.
- mortality : COVID-19.
- statistics & numerical data : Hospitalization, Respiration, Artificial.
- chemical , therapeutic use : Glucocorticoids, Hydroxychloroquine.
- therapy : COVID-19.
- Aged, Comorbidity, Female, Heart Transplantation, Humans, Male, Middle Aged, Retrospective Studies, Transplant Recipients.
Abstract
Importance
Recipients of heart transplant (HT) may be at increased risk of adverse outcomes attributable to infection with coronavirus disease 2019 (COVID-19) because of multiple comorbidities and clinically significant immunosuppression.
Objective
To describe the characteristics, treatment, and outcomes of recipients of HT with COVID-19.
Design, Setting, and Participants
This case series from a single large academic heart transplant program in New York, New York, incorporates data from between March 1, 2020, and April 24, 2020. All recipients of HT followed up by this center who were infected with COVID-19 were included.
Interventions
Heart transplant and a confirmed diagnosis of COVID-19.
Main Outcomes and Measures
The primary measure was vital status at end of study follow-up. Secondary measures included patient characteristics, laboratory analyses, changes to immunosuppression, and treatment administered for COVID-19.
Results
Twenty-eight patients with HT received a confirmed diagnosis of COVID-19. The median age was 64.0 (interquartile range [IQR], 53.5-70.5) years, 22 (79%) were men, and the median time from HT was 8.6 (IQR, 4.2-14.5) years. Comorbid conditions included hypertension in 20 patients (71%), diabetes in 17 patients (61%), and cardiac allograft vasculopathy in 16 patients (57%). Twenty-two participants (79%) were admitted for treatment, and 7 (25%) required mechanical ventilation. Most (13 of 17 [76%]) had evidence of myocardial injury (median high-sensitivity troponin T, 0.055 [IQR, 0.0205-0.1345] ng/mL) and elevated inflammatory biomarkers (median peak high-sensitivity C-reactive protein, 11.83 [IQR, 7.44-19.26] mg/dL; median peak interleukin 6, 105 [IQR, 38-296] pg/mL). Among patients managed at the study institution, mycophenolate mofetil was discontinued in 16 patients (70%), and 6 (26%) had a reduction in the dose of their calcineurin inhibitor. Treatment of COVID-19 included hydroxychloroquine (18 patients [78%]), high-dose corticosteroids (8 patients [47%]), and interleukin 6 receptor antagonists (6 patients [26%]). Overall, 7 patients (25%) died. Among 22 patients (79%) who were admitted, 11 (50%) were discharged home, 4 (18%) remain hospitalized at the end of the study, and 7 (32%) died during hospitalization.
Conclusions and Relevance
In this single-center case series, COVID-19 infection was associated with a case fatality rate of 25% in recipients of HT. Immunosuppression was reduced in most of this group of patients. Further study is required to evaluate the optimal approach to management of COVID-19 infection in the HT population.
DOI: 10.1001/jamacardio.2020.2159
PubMed: 32402056
PubMed Central: PMC7221850
Links to Exploration step
pubmed:32402056Le document en format XML
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Clerkin</name><affiliation><nlm:affiliation>Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</nlm:affiliation></affiliation></author><author><name sortKey="Habal, Marlena V" sort="Habal, Marlena V" uniqKey="Habal M" first="Marlena V" last="Habal">Marlena V. 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Farr</name><affiliation><nlm:affiliation>Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</nlm:affiliation></affiliation></author><author><name sortKey="Clerkin, Kevin J" sort="Clerkin, Kevin J" uniqKey="Clerkin K" first="Kevin J" last="Clerkin">Kevin J. Clerkin</name><affiliation><nlm:affiliation>Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</nlm:affiliation></affiliation></author><author><name sortKey="Habal, Marlena V" sort="Habal, Marlena V" uniqKey="Habal M" first="Marlena V" last="Habal">Marlena V. Habal</name><affiliation><nlm:affiliation>Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</nlm:affiliation></affiliation></author><author><name sortKey="Takeda, Koji" sort="Takeda, Koji" uniqKey="Takeda K" first="Koji" last="Takeda">Koji Takeda</name><affiliation><nlm:affiliation>Division of Cardiac Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</nlm:affiliation></affiliation></author><author><name sortKey="Naka, Yoshifumi" sort="Naka, Yoshifumi" uniqKey="Naka Y" first="Yoshifumi" last="Naka">Yoshifumi Naka</name><affiliation><nlm:affiliation>Division of Cardiac Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</nlm:affiliation></affiliation></author><author><name sortKey="Restaino, Susan" sort="Restaino, Susan" uniqKey="Restaino S" first="Susan" last="Restaino">Susan Restaino</name><affiliation><nlm:affiliation>Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</nlm:affiliation></affiliation></author><author><name sortKey="Sayer, Gabriel" sort="Sayer, Gabriel" uniqKey="Sayer G" first="Gabriel" last="Sayer">Gabriel Sayer</name><affiliation><nlm:affiliation>Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</nlm:affiliation></affiliation></author><author><name sortKey="Uriel, Nir" sort="Uriel, Nir" uniqKey="Uriel N" first="Nir" last="Uriel">Nir Uriel</name><affiliation><nlm:affiliation>Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</nlm:affiliation></affiliation></author></analytic><series><title level="j">JAMA cardiology</title><idno type="eISSN">2380-6591</idno><imprint><date when="2020" type="published">2020</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Aged (MeSH)</term><term>Biomarkers (blood)</term><term>C-Reactive Protein (analysis)</term><term>COVID-19 (mortality)</term><term>COVID-19 (therapy)</term><term>Comorbidity (MeSH)</term><term>Female (MeSH)</term><term>Glucocorticoids (therapeutic use)</term><term>Heart Transplantation (MeSH)</term><term>Hospitalization (statistics & numerical data)</term><term>Humans (MeSH)</term><term>Hydroxychloroquine (therapeutic use)</term><term>Immunosuppressive Agents (administration & dosage)</term><term>Interleukin-6 (blood)</term><term>Male (MeSH)</term><term>Middle Aged (MeSH)</term><term>New York City (epidemiology)</term><term>Receptors, Interleukin-6 (antagonists & inhibitors)</term><term>Respiration, Artificial (statistics & numerical data)</term><term>Retrospective Studies (MeSH)</term><term>Transplant Recipients (MeSH)</term><term>Troponin T (blood)</term></keywords><keywords scheme="MESH" type="chemical" qualifier="administration & dosage" xml:lang="en"><term>Immunosuppressive Agents</term></keywords><keywords scheme="MESH" type="chemical" qualifier="analysis" xml:lang="en"><term>C-Reactive Protein</term></keywords><keywords scheme="MESH" type="chemical" qualifier="antagonists & inhibitors" xml:lang="en"><term>Receptors, Interleukin-6</term></keywords><keywords scheme="MESH" type="chemical" qualifier="blood" xml:lang="en"><term>Biomarkers</term><term>Interleukin-6</term><term>Troponin T</term></keywords><keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>New York City</term></keywords><keywords scheme="MESH" qualifier="mortality" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" qualifier="statistics & numerical data" xml:lang="en"><term>Hospitalization</term><term>Respiration, Artificial</term></keywords><keywords scheme="MESH" type="chemical" qualifier="therapeutic use" xml:lang="en"><term>Glucocorticoids</term><term>Hydroxychloroquine</term></keywords><keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>COVID-19</term></keywords><keywords scheme="MESH" xml:lang="en"><term>Aged</term><term>Comorbidity</term><term>Female</term><term>Heart Transplantation</term><term>Humans</term><term>Male</term><term>Middle Aged</term><term>Retrospective Studies</term><term>Transplant Recipients</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>Importance</b></p><p>Recipients of heart transplant (HT) may be at increased risk of adverse outcomes attributable to infection with coronavirus disease 2019 (COVID-19) because of multiple comorbidities and clinically significant immunosuppression.</p></div><div type="abstract" xml:lang="en"><p><b>Objective</b></p><p>To describe the characteristics, treatment, and outcomes of recipients of HT with COVID-19.</p></div><div type="abstract" xml:lang="en"><p><b>Design, Setting, and Participants</b></p><p>This case series from a single large academic heart transplant program in New York, New York, incorporates data from between March 1, 2020, and April 24, 2020. All recipients of HT followed up by this center who were infected with COVID-19 were included.</p></div><div type="abstract" xml:lang="en"><p><b>Interventions</b></p><p>Heart transplant and a confirmed diagnosis of COVID-19.</p></div><div type="abstract" xml:lang="en"><p><b>Main Outcomes and Measures</b></p><p>The primary measure was vital status at end of study follow-up. Secondary measures included patient characteristics, laboratory analyses, changes to immunosuppression, and treatment administered for COVID-19.</p></div><div type="abstract" xml:lang="en"><p><b>Results</b></p><p>Twenty-eight patients with HT received a confirmed diagnosis of COVID-19. The median age was 64.0 (interquartile range [IQR], 53.5-70.5) years, 22 (79%) were men, and the median time from HT was 8.6 (IQR, 4.2-14.5) years. Comorbid conditions included hypertension in 20 patients (71%), diabetes in 17 patients (61%), and cardiac allograft vasculopathy in 16 patients (57%). Twenty-two participants (79%) were admitted for treatment, and 7 (25%) required mechanical ventilation. Most (13 of 17 [76%]) had evidence of myocardial injury (median high-sensitivity troponin T, 0.055 [IQR, 0.0205-0.1345] ng/mL) and elevated inflammatory biomarkers (median peak high-sensitivity C-reactive protein, 11.83 [IQR, 7.44-19.26] mg/dL; median peak interleukin 6, 105 [IQR, 38-296] pg/mL). Among patients managed at the study institution, mycophenolate mofetil was discontinued in 16 patients (70%), and 6 (26%) had a reduction in the dose of their calcineurin inhibitor. Treatment of COVID-19 included hydroxychloroquine (18 patients [78%]), high-dose corticosteroids (8 patients [47%]), and interleukin 6 receptor antagonists (6 patients [26%]). Overall, 7 patients (25%) died. Among 22 patients (79%) who were admitted, 11 (50%) were discharged home, 4 (18%) remain hospitalized at the end of the study, and 7 (32%) died during hospitalization.</p></div><div type="abstract" xml:lang="en"><p><b>Conclusions and Relevance</b></p><p>In this single-center case series, COVID-19 infection was associated with a case fatality rate of 25% in recipients of HT. Immunosuppression was reduced in most of this group of patients. Further study is required to evaluate the optimal approach to management of COVID-19 infection in the HT population.</p></div></front></TEI><pubmed><MedlineCitation Status="MEDLINE" Owner="NLM"><PMID Version="1">32402056</PMID><DateCompleted><Year>2021</Year><Month>05</Month><Day>17</Day></DateCompleted><DateRevised><Year>2021</Year><Month>05</Month><Day>17</Day></DateRevised><Article PubModel="Print"><Journal><ISSN IssnType="Electronic">2380-6591</ISSN><JournalIssue CitedMedium="Internet"><Volume>5</Volume><Issue>10</Issue><PubDate><Year>2020</Year><Month>10</Month><Day>01</Day></PubDate></JournalIssue><Title>JAMA cardiology</Title><ISOAbbreviation>JAMA Cardiol</ISOAbbreviation></Journal><ArticleTitle>Characteristics and Outcomes of Recipients of Heart Transplant With Coronavirus Disease 2019.</ArticleTitle><Pagination><MedlinePgn>1165-1169</MedlinePgn></Pagination><ELocationID EIdType="doi" ValidYN="Y">10.1001/jamacardio.2020.2159</ELocationID><Abstract><AbstractText Label="Importance">Recipients of heart transplant (HT) may be at increased risk of adverse outcomes attributable to infection with coronavirus disease 2019 (COVID-19) because of multiple comorbidities and clinically significant immunosuppression.</AbstractText><AbstractText Label="Objective">To describe the characteristics, treatment, and outcomes of recipients of HT with COVID-19.</AbstractText><AbstractText Label="Design, Setting, and Participants">This case series from a single large academic heart transplant program in New York, New York, incorporates data from between March 1, 2020, and April 24, 2020. All recipients of HT followed up by this center who were infected with COVID-19 were included.</AbstractText><AbstractText Label="Interventions">Heart transplant and a confirmed diagnosis of COVID-19.</AbstractText><AbstractText Label="Main Outcomes and Measures">The primary measure was vital status at end of study follow-up. Secondary measures included patient characteristics, laboratory analyses, changes to immunosuppression, and treatment administered for COVID-19.</AbstractText><AbstractText Label="Results">Twenty-eight patients with HT received a confirmed diagnosis of COVID-19. The median age was 64.0 (interquartile range [IQR], 53.5-70.5) years, 22 (79%) were men, and the median time from HT was 8.6 (IQR, 4.2-14.5) years. Comorbid conditions included hypertension in 20 patients (71%), diabetes in 17 patients (61%), and cardiac allograft vasculopathy in 16 patients (57%). Twenty-two participants (79%) were admitted for treatment, and 7 (25%) required mechanical ventilation. Most (13 of 17 [76%]) had evidence of myocardial injury (median high-sensitivity troponin T, 0.055 [IQR, 0.0205-0.1345] ng/mL) and elevated inflammatory biomarkers (median peak high-sensitivity C-reactive protein, 11.83 [IQR, 7.44-19.26] mg/dL; median peak interleukin 6, 105 [IQR, 38-296] pg/mL). Among patients managed at the study institution, mycophenolate mofetil was discontinued in 16 patients (70%), and 6 (26%) had a reduction in the dose of their calcineurin inhibitor. Treatment of COVID-19 included hydroxychloroquine (18 patients [78%]), high-dose corticosteroids (8 patients [47%]), and interleukin 6 receptor antagonists (6 patients [26%]). Overall, 7 patients (25%) died. Among 22 patients (79%) who were admitted, 11 (50%) were discharged home, 4 (18%) remain hospitalized at the end of the study, and 7 (32%) died during hospitalization.</AbstractText><AbstractText Label="Conclusions and Relevance">In this single-center case series, COVID-19 infection was associated with a case fatality rate of 25% in recipients of HT. Immunosuppression was reduced in most of this group of patients. Further study is required to evaluate the optimal approach to management of COVID-19 infection in the HT population.</AbstractText></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Latif</LastName><ForeName>Farhana</ForeName><Initials>F</Initials><AffiliationInfo><Affiliation>Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Farr</LastName><ForeName>Maryjane A</ForeName><Initials>MA</Initials><AffiliationInfo><Affiliation>Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Clerkin</LastName><ForeName>Kevin J</ForeName><Initials>KJ</Initials><AffiliationInfo><Affiliation>Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Habal</LastName><ForeName>Marlena V</ForeName><Initials>MV</Initials><AffiliationInfo><Affiliation>Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Takeda</LastName><ForeName>Koji</ForeName><Initials>K</Initials><AffiliationInfo><Affiliation>Division of Cardiac Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Naka</LastName><ForeName>Yoshifumi</ForeName><Initials>Y</Initials><AffiliationInfo><Affiliation>Division of Cardiac Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Restaino</LastName><ForeName>Susan</ForeName><Initials>S</Initials><AffiliationInfo><Affiliation>Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Sayer</LastName><ForeName>Gabriel</ForeName><Initials>G</Initials><AffiliationInfo><Affiliation>Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y"><LastName>Uriel</LastName><ForeName>Nir</ForeName><Initials>N</Initials><AffiliationInfo><Affiliation>Division of Cardiology, Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, New York.</Affiliation></AffiliationInfo></Author></AuthorList><Language>eng</Language><GrantList CompleteYN="Y"><Grant><GrantID>K23 HL148528</GrantID><Acronym>HL</Acronym><Agency>NHLBI NIH HHS</Agency><Country>United States</Country></Grant></GrantList><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType><PublicationType UI="D052061">Research Support, N.I.H., Extramural</PublicationType></PublicationTypeList></Article><MedlineJournalInfo><Country>United States</Country><MedlineTA>JAMA Cardiol</MedlineTA><NlmUniqueID>101676033</NlmUniqueID></MedlineJournalInfo><ChemicalList><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D015415">Biomarkers</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D005938">Glucocorticoids</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D007166">Immunosuppressive Agents</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D015850">Interleukin-6</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D019947">Receptors, Interleukin-6</NameOfSubstance></Chemical><Chemical><RegistryNumber>0</RegistryNumber><NameOfSubstance UI="D020107">Troponin T</NameOfSubstance></Chemical><Chemical><RegistryNumber>4QWG6N8QKH</RegistryNumber><NameOfSubstance UI="D006886">Hydroxychloroquine</NameOfSubstance></Chemical><Chemical><RegistryNumber>9007-41-4</RegistryNumber><NameOfSubstance UI="D002097">C-Reactive Protein</NameOfSubstance></Chemical></ChemicalList><CitationSubset>IM</CitationSubset><MeshHeadingList><MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D015415" MajorTopicYN="N">Biomarkers</DescriptorName><QualifierName UI="Q000097" MajorTopicYN="N">blood</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D002097" MajorTopicYN="N">C-Reactive Protein</DescriptorName><QualifierName UI="Q000032" MajorTopicYN="N">analysis</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D000086382" MajorTopicYN="N">COVID-19</DescriptorName><QualifierName UI="Q000401" MajorTopicYN="Y">mortality</QualifierName><QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015897" MajorTopicYN="N">Comorbidity</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D005938" MajorTopicYN="N">Glucocorticoids</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D016027" MajorTopicYN="Y">Heart Transplantation</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006760" MajorTopicYN="N">Hospitalization</DescriptorName><QualifierName UI="Q000706" MajorTopicYN="Y">statistics & numerical data</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D006886" MajorTopicYN="N">Hydroxychloroquine</DescriptorName><QualifierName UI="Q000627" MajorTopicYN="N">therapeutic use</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D007166" MajorTopicYN="N">Immunosuppressive Agents</DescriptorName><QualifierName UI="Q000008" MajorTopicYN="N">administration & dosage</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D015850" MajorTopicYN="N">Interleukin-6</DescriptorName><QualifierName UI="Q000097" MajorTopicYN="N">blood</QualifierName></MeshHeading><MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName></MeshHeading><MeshHeading><DescriptorName UI="D009519" MajorTopicYN="N" Type="Geographic">New York City</DescriptorName><QualifierName 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