1
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Li J, Cao P, Chen Z, Deng R, Nie Y, Pang F, Liu X, Huang H, Yang J, Zhong K, Lai Y. Immune response analysis of solid organ transplantation recipients inoculated with inactivated COVID-19 vaccine: A retrospective analysis. Open Med (Wars) 2024; 19:20240980. [PMID: 38911255 PMCID: PMC11193357 DOI: 10.1515/med-2024-0980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/25/2024] Open
Abstract
Objective This study aimed to evaluate the efficacy and safety of solid organ transplantation recipients inoculated with an inactivated COVID-19 vaccine. Methods We retrospectively analyzed the antibody levels and related adverse events of non-transplantation subjects and solid organ transplant recipients, both pre-transplantation (individuals awaiting organ transplantation) and post-transplantation (individuals who have undergone organ transplantation), who received inactivated COVID-19 vaccines from February 2021 to July 2022. Results The study included 38 pre-transplantation vaccination group, 129 post-transplantation vaccination group, and 246 non-transplantation group. The antibody titer was assessed monthly within the period of 1-12 months after the last injection. The antibody-positive rate among the three groups were 36.84, 20.30, 61.17% (P < 0.05). The antibody-positive rates among three groups with one, two doses vaccine were not significantly different (P > 0.05), but were significantly different after three doses (P < 0.05). The antibody titers among three groups were significantly different after two doses (P < 0.05). Adverse reactions occurred in six transplant recipients, which were relieved after treatment, and not in the non-transplantation subjects. Conclusion Inactivated COVID-19 vaccine is safe and effective for solid organ transplantation recipients, at least two doses of which should be completed before organ transplant surgery.
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Affiliation(s)
- Jiazhi Li
- Department of Transplantation, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning530021, Guangxi, China
| | - Peihua Cao
- Clinical Research Center, Zhujiang Hospital, Southern Medical University, Guangzhou510280, Guangdong, China
| | - Zhenhu Chen
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou510280, Guangdong, China
| | - Ruihua Deng
- Department of Transplantation, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning530021, Guangxi, China
| | - Yu Nie
- General Surgery Center, Department of Hepatobiliary Surgery II and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou510280, Guangdong, China
| | - Feixiong Pang
- Department of Transplantation, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning530021, Guangxi, China
| | - Xiaomian Liu
- Department of Transplantation, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning530021, Guangxi, China
| | - Haijia Huang
- Department of Transplantation, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning530021, Guangxi, China
| | - Jianrong Yang
- Department of Transplantation, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning530021, Guangxi, China
| | - Kebo Zhong
- General Surgery Center, Department of Hepatobiliary Surgery II and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou510280, Guangdong, China
| | - Yanhua Lai
- Department of Biostatistics, School of Public Health, Southern Medical University, Guangzhou510280, Guangdong, China
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2
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Tamimi O, Tamimi F, Nisar T, Gaber AO, Lin J, Gorthi J, Gotur D. Clinical Outcomes of Heart Transplant Recipients Admitted with COVID-19 Infection in 2020: A Nationwide Analysis. Curr Probl Cardiol 2023; 48:101996. [PMID: 37506956 DOI: 10.1016/j.cpcardiol.2023.101996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
The COVID-19 pandemic, caused by infection of the SARS-CoV-2 virus, has impacted morbidity and mortality through widespread cytokine release and aberrant immunity; the mainstay of management has been immunosuppression. The aim of our retrospective study is to determine the effects of solid-organ transplantation (SOT) on COVID-19 admissions using data from the 2020 nationwide inpatient sample (NIS). After multivariate adjustment, we found COVID-19 admission with SOT had no difference in mortality (11.5% vs 11.1%, adjusted OR: 0.99 [95% CI 0.84-1.19, P = 0.99], no difference in need for vasopressor use (2.6% vs 1.8%, adjusted OR: 1.02 [95% CI 0.73-1.44, P = 0.88]), lower odds of requiring mechanical ventilation (MV) (13.7% vs 14.8%, adjusted OR: 0.83 [95% CI 0.71-0.97, P = 0.02]), lower odds of MV within 24 hours of admission (adjusted OR: 0.60 [95% CI 0.47-0.78, P < 0.01]), increased odds of mechanical circulatory support needs (adjusted OR 3.7 [95% CI 1.2-11.7, P = 0.025]), increased odds of acute renal failure requiring renal replacement therapy (adjusted OR 1.66 [95% CI 1.29-2.15, P < 0.01]), decreased mean length of stay (7.45 days vs 7.48 days, adjusted difference: 0.8 days less, P <0.01), and no difference in mean total hospitalization charges ($91,316 vs $79,100, adjusted difference: -$2,667, P = 0.57) compared to COVID-19 admissions without SOT.
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Affiliation(s)
- Omar Tamimi
- Department of Medicine, Houston Methodist Hospital, Houston, TX.
| | - Faisal Tamimi
- Department of Medicine, Jamaica Medical Center, Queens, NY
| | - Tariq Nisar
- Center for Health Data Science and Analytics, Houston Methodist Research Institute, Houston TX
| | - Ahmed Osama Gaber
- Department of Surgery, Houston Methodist Hospital, Houston, TX; J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX
| | - Jiejian Lin
- Department of Medicine, Houston Methodist Hospital, Houston, TX; Division of Infectious Disease, Houston Methodist Hospital, Houston, TX
| | - Janardhana Gorthi
- Department of Medicine, Houston Methodist Hospital, Houston, TX; J.C. Walter Jr. Transplant Center, Houston Methodist Hospital, Houston, TX; Division of Cardiology, Houston Methodist Hospital, Houston TX
| | - Deepa Gotur
- Department of Medicine, Houston Methodist Hospital, Houston, TX; Division of Critical Care, Houston Methodist Hospital, Houston, TX
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3
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Chavarin DJ, Bobba A, Davis MG, Roth MA, Kasdorf M, Nasrullah A, Chourasia P, Gangu K, Avula SR, Sheikh AB. Comparative Analysis of Clinical Outcomes for COVID-19 and Influenza among Cardiac Transplant Recipients in the United States. Viruses 2023; 15:1700. [PMID: 37632042 PMCID: PMC10458639 DOI: 10.3390/v15081700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 07/30/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
COVID-19 infections can lead to worse outcomes in an immunocompromised population with multiple comorbidities, e.g., heart transplant patients. We used the National Inpatient Sample database to compare heart transplant outcomes in patients with COVID-19 vs. influenza. A total of 2460 patients were included in this study: heart transplant with COVID-19 (n = 1155, 47.0%) and heart transplant with influenza (n = 1305, 53.0%) with the primary outcome of in-hospital mortality. In-hospital mortality (n = 120) was significantly higher for heart transplant patients infected with COVID-19 compared to those infected with influenza (9.5% vs. 0.8%, adjusted OR: 51.6 [95% CI 4.3-615.9], p = 0.002) along with significantly higher rates of mechanical ventilation, acute heart failure, ventricular arrhythmias, and higher mean total hospitalization cost compared to the influenza group. More studies are needed on the role of vaccination and treatment to improve outcomes in this vulnerable population.
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Affiliation(s)
- Daniel J. Chavarin
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Aniesh Bobba
- Department of Medicine, John H Stronger Hospital, Chicago, IL 60612, USA;
| | - Monique G. Davis
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | - Margaret A. Roth
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
| | | | - Adeel Nasrullah
- Division of Pulmonology and Critical Care, Allegheny Health Network, Pittsburgh, PA 15212, USA
| | - Prabal Chourasia
- Department of Hospital Medicine, Mary Washington Hospital, Fredericksburg, VA 22401, USA
| | - Karthik Gangu
- Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA;
| | - Sindhu Reddy Avula
- Department of Interventional Cardiology, Division of Cardiology, University of Kansas, Kansas City, KS 66606, USA;
| | - Abu Baker Sheikh
- Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM 87106, USA
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4
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Greenberg D, Li B, Okumura K, Nabors C, Dhand A. Coronavirus Disease 2019 and Heart Transplantation: Single-Center Experience and Review of the Literature. Cardiol Rev 2023; 31:168-172. [PMID: 35679025 DOI: 10.1097/crd.0000000000000464] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Coronavirus disease 2019 (COVID-19) was declared a global pandemic in March 2020, and since then it has had a significant impact on healthcare including on solid organ transplantation. Based on age, immunosuppression, and prevalence of chronic comorbidities, heart transplant recipients are at high risk of adverse outcomes associated with COVID-19. In our center, 31 heart transplant recipients were diagnosed with COVID-19 from March 2020 to September 2021. They required: hospitalization (39%), intensive care (10%), and mechanical ventilation (6%) with overall short-term mortality of 3%. Early outpatient use of anti-SARS CoV-2 monoclonal antibodies in our heart transplant recipients was associated with a reduction in the risk of hospitalization, need for intensive care, and death related to COVID-19. In prior multicenter studies, completed in different geographic areas and pandemic timeframes, diverse rates of hospitalization (38-91%), mechanical ventilation (4-38%), and death (16-33%) have been reported. Progression of disease and adverse outcomes were most significantly associated with severity of lymphopenia, chronic comorbid conditions like older age, chronic allograft vasculopathy, increased body mass index, as well as intensity of baseline immune suppression. In this article, we also review the current roles and limitations of vaccination, anti-viral agents, and anti-severe acute respiratory syndrome coronavirus 2 monoclonal antibodies in the management of heart transplant recipients. Our single-center experience, considered together with other studies indicates a trend toward improved outcomes among heart transplant patients with COVID-19.
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Affiliation(s)
- Daniel Greenberg
- From the Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY
| | - Bo Li
- From the Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY
| | - Kenji Okumura
- Department of Surgery, New York Medical College/Westchester Medical Center, Valhalla, NY
| | - Christopher Nabors
- From the Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY
| | - Abhay Dhand
- From the Department of Medicine, New York Medical College/Westchester Medical Center, Valhalla, NY
- Department of Surgery, New York Medical College/Westchester Medical Center, Valhalla, NY
- Transplant Infectious Diseases, New York Medical College/Westchester Medical Center, Valhalla, NY
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5
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Hashem M, El-Kassas M. Diagnosis, treatment protocols, and outcomes of liver transplant recipients infected with COVID-19. World J Clin Cases 2023; 11:2140-2159. [PMID: 37122505 PMCID: PMC10131019 DOI: 10.12998/wjcc.v11.i10.2140] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 01/20/2023] [Accepted: 03/09/2023] [Indexed: 03/30/2023] Open
Abstract
Several cases of fatal pneumonia during November 2019 were linked initially to severe acute respiratory syndrome coronavirus 2, which the World Health Organization later designated as coronavirus disease 2019 (COVID-19). The World Health Organization declared COVID-19 as a pandemic on March 11, 2020. In the general population, COVID-19 severity can range from asymptomatic/mild symptoms to seriously ill. Its mortality rate could be as high as 49%. The Centers for Disease Control and Prevention have acknowledged that people with specific underlying medical conditions, among those who need immunosuppression after solid organ transplantation (SOT), are at an increased risk of developing severe illness from COVID-19. Liver transplantation is the second most prevalent SOT globally. Due to their immunosuppressed state, liver transplant (LT) recipients are more susceptible to serious infections. Therefore, comorbidities and prolonged immunosuppression among SOT recipients enhance the likelihood of severe COVID-19. It is crucial to comprehend the clinical picture, immunosuppressive management, prognosis, and prophylaxis of COVID-19 infection because it may pose a danger to transplant recipients. This review described the clinical and laboratory findings of COVID-19 in LT recipients and the risk factors for severe disease in this population group. In the following sections, we discussed current COVID-19 therapy choices, reviewed standard practice in modifying immunosuppressant regimens, and outlined the safety and efficacy of currently licensed drugs for inpatient and outpatient management. Additionally, we explored the clinical outcomes of COVID-19 in LT recipients and mentioned the efficacy and safety of vaccination use.
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Affiliation(s)
- Mai Hashem
- Fellow of Tropical Medicine and Gastroenterology, Assiut University Hospital, Assiut 71515, Egypt
| | - Mohamed El-Kassas
- Department of Endemic Medicine, Faculty of Medicine, Helwan University, Cairo 11795, Egypt
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6
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Garcia LR, Garzesi AM, Sinatora JB, Grotto RMT, Passaroni AC, de Campos NLKL, Martins AS, Felicio ML, Brito FDS. Orthotopic Heart Transplantation in a Covid-19 Recipient. Arq Bras Cardiol 2023; 120:e20220234. [PMID: 37018788 PMCID: PMC10392859 DOI: 10.36660/abc.20220234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 08/03/2022] [Accepted: 09/21/2022] [Indexed: 04/07/2023] Open
Affiliation(s)
- Leonardo Rufino Garcia
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - André Monti Garzesi
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Julia Bazzo Sinatora
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Rejane Maria Tommasini Grotto
- Laboratório de Biotecnologia AplicadaHospital das Clínicas de BotucatuUNESPBotucatuSPBrasilLaboratório de Biotecnologia Aplicada do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Andréia Cristina Passaroni
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Nelson Leonardo Kerdahi Leite de Campos
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Antônio Sérgio Martins
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Marcello Laneza Felicio
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
| | - Flávio de Souza Brito
- Hospital das Clínicas de BotucatuUNESPBotucatuSPBrasilServiço de Cirurgia Cardiovascular e Transplante Cardíaco do Hospital das Clínicas de Botucatu – UNESP, Botucatu, SP – Brasil
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7
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Lin H, Gao Y, Qiu Y, Du W, Zhu H, Li J, Wang P, Xu Y, Feng Y. Impact of age group on bloodstream infection risk evaluation in immunosuppressed patients: a retrospective, single-centre, 5-year cohort study. Aging Clin Exp Res 2023; 35:357-366. [PMID: 36394798 DOI: 10.1007/s40520-022-02299-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/02/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Elderly patients in immunosuppressive status may have an increased occurrence of illness and risk of poor prognosis. It is a generally overlooked population that we should pay more attention to their risk factors of sickness and mortality. METHODS Eight hundred and nine patients who were diagnosed with bloodstream infection in immunosuppressive states during accepting treatment in our hospital were selected from 2015 to 2019.The demographic data, underlying diseases, comorbidity, inducement, complications, pathogen sources, etiologies, and the antibiotics therapy were analyzed between ages > 65 years groups and ages < 65 years groups. RESULTS The clinical characteristics of totally 809 immunosuppressed people diagnosed with bloodstream infection were analyzed, and among those people about 371 were ages > 65 years. By univariate logistic regression analysis and multivariate logistic regression analysis, we found that hypertension (OR: 2.864, 95% CI 2.024-4.051, P < 0.0001), cerebral Infarction (OR: 4.687, 95% CI 2.056-10.686, P < 0.0001), coronary heart disease (OR: 1.942, 95% CI 1.168-3.230, P = 0.011), acute pancreatitis (OR: 3.964, 95% CI 2.059-7.632, P < 0.0001), infective endocarditis (OR: 6.846, 95% CI 1.828-25.644, P = 0.004), aortic dissection (OR: 9.131, 95% CI 3.190-26.085, P < 0.0001), chemotherapy (OR: 3.462, 95% CI 1.815-6.603, P < 0.0001), transplant status (OR: 20.031, 95% CI 4.193-95.697, P < 0.0001), and respiratory tract infection (OR: 2.096, 95% CI 1.269-3.461, P = 0.004) were significantly different between ages > 65 years groups and ages < 65 years groups. CONCLUSION Hypertension, cerebral Infarction, coronary heart disease, acute pancreatitis, infective endocarditis, aortic dissection, chemotherapy, transplant status, and pathogen source of respiratory tract were the independent risk factors of ages > 65 years in immunosuppressed patients, which would have the benefit to discriminate the prognostic factors in immunosuppressive elderly people with bloodstream infection.
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Affiliation(s)
- Hongxia Lin
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiaotong University, Shanghai, 20025, China
| | - Yulian Gao
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiaotong University, Shanghai, 20025, China
| | - Yanli Qiu
- Department of Anesthesia, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
| | - Wei Du
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiaotong University, Shanghai, 20025, China
| | - Haixing Zhu
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiaotong University, Shanghai, 20025, China
| | - Junjie Li
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiaotong University, Shanghai, 20025, China
| | - Ping Wang
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiaotong University, Shanghai, 20025, China.
| | - Yumin Xu
- Department of Hospital Infection Management, Department of Infectious Diseases, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
| | - Yun Feng
- Department of Respiratory and Critical Care Medicine, Ruijin Hospital Affiliated Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
- Institute of Respiratory Diseases, School of Medicine, Shanghai Jiaotong University, Shanghai, 20025, China.
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8
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Memenga F, Kueppers ST, Borof K, Kirchhof P, Duengelhoef PM, Barten MJ, Lütgehetmann M, Berisha F, Fluschnik N, Becher PM, Kondziella C, Bernhardt AM, Reichenspurner H, Blankenberg S, Magnussen C, Rybczynski M. SARS-CoV-2 Vaccination-Induced Immunogenicity in Heart Transplant Recipients. Transpl Int 2023; 36:10883. [PMID: 36814697 PMCID: PMC9939437 DOI: 10.3389/ti.2023.10883] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 01/19/2023] [Indexed: 02/07/2023]
Abstract
Among heart transplant (HT) recipients, a reduced immunological response to SARS-CoV-2 vaccination has been reported. We aimed to assess the humoral and T-cell response to SARS-CoV-2 vaccination in HT recipients to understand determinants of immunogenicity. HT recipients were prospectively enrolled from January 2021 until March 2022. Anti-SARS-CoV-2-Spike IgG levels were quantified after two and three doses of a SARS-CoV-2 vaccine (BNT162b2, mRNA1273, or AZD1222). Spike-specific T-cell responses were assessed using flow cytometry. Ninety-one patients were included in the study (69% male, median age 55 years, median time from HT to first vaccination 6.1 years). Seroconversion rates were 34% after two and 63% after three doses. Older patient age (p = 0.003) and shorter time since HT (p = 0.001) were associated with lower antibody concentrations after three vaccinations. There were no associations between vaccine types or immunosuppressive regimens and humoral response, except for prednisolone, which was predictive of a reduced response after two (p = 0.001), but not after three doses (p = 0.434). A T-cell response was observed in 50% after two and in 74% after three doses. Despite three vaccine doses, a large proportion of HT recipients exhibits a reduced immune response. Additional strategies are desirable to improve vaccine immunogenicity in this vulnerable group of patients.
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Affiliation(s)
- Felix Memenga
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Simon Thomas Kueppers
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Katrin Borof
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Paulus Kirchhof
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | | | - Markus Johannes Barten
- Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marc Lütgehetmann
- Institute of Medical Microbiology, Virology and Hygiene, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Infection Research (DZIF), Partner Site Hamburg/Lübeck/Borstel/Riems, Hamburg, Germany
| | - Filip Berisha
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Nina Fluschnik
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Peter Moritz Becher
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Christoph Kondziella
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander M Bernhardt
- Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hermann Reichenspurner
- Department of Cardiovascular Surgery, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Christina Magnussen
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany
| | - Meike Rybczynski
- Department of Cardiology, University Heart and Vascular Center, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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9
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Sahota A, Tien A, Yao J, Dong E, Herald J, Javaherifar S, Neyer J, Hwang J, Lee R, Fong TL. Incidence, Risk Factors, and Outcomes of COVID-19 Infection in a Large Cohort of Solid Organ Transplant Recipients. Transplantation 2022; 106:2426-2434. [PMID: 36436102 PMCID: PMC9696760 DOI: 10.1097/tp.0000000000004371] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/31/2022] [Accepted: 08/13/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Solid organ transplant recipients (SOTr) are at increased risk for severe disease from coronavirus disease 2019 (COVID-19) compared with non-SOTr. METHODS We performed a retrospective cohort study between March 1, 2020, and March, 30, 2021, in an integrated healthcare system with 4.3 million members aged ≥18 y including 5126 SOTr. Comparisons in COVID-19 mortality, hospitalization, and incidence were made between SOTr and non-SOTr, and between different SOTr organs. Multivariate analysis was performed to identify risk factors for COVID-19 mortality and hospitalization. RESULTS There were 600 SOTr (kidney, liver, heart, and lung) with COVID-19. Per person-year incidence of COVID-19 among SOTr was 10.0% versus 7.6% among non-SOTr (P < 0.0001). Compared with uninfected SOTr, infected SOTr were older (57.1 ± 14.0 versus 45.7 ± 17.9 y, P < 0.001), predominantly Hispanic/Latino (58.8% versus 38.6%, P < 0.0001), hypertensive (77.0% versus 23.8%; P < 0.0001), and diabetic (49.6% versus 13.0%; P = 0.0009). Compared with non-SOTr, infected SOTr had higher hospitalization (39.5% versus 6.0%; P < 0.0001), intensive care unit admission (29.1% versus 15.5%; P < 0.0001), and mortality (14.7% versus 1.8%; P < 0.0001) from COVID-19. Older age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.05-1.10), male gender (HR, 1.79; 95% CI, 1.11-2.86), and higher body mass index (HR, 1.04; 95% CI, 1.00-1.09; P = 0.047) were associated with increased mortality from COVID-19, whereas race, diabetes, and number/type of immunosuppressive medications were not. Among the different SOTr, COVID-19 mortality risk was lowest in liver recipients (HR, 0.34; 95% CI, 0.16-0.73) and highest in lung recipients (HR, 1.74; 95% CI, 0.68-4.42). CONCLUSIONS SOTr have higher rates of hospitalization and mortality from COVID-19 compared with the general population. Among the SOTr, the incidence and outcomes were distinct among different transplantation types.
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Affiliation(s)
- Amandeep Sahota
- Department of Transplant Hepatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Andy Tien
- Department of Transplant Hepatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Janis Yao
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Elizabeth Dong
- Department of Transplant Hepatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - John Herald
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Sarah Javaherifar
- Department of Internal Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Jonathan Neyer
- Department of Cardiology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Jennifer Hwang
- Department of Transplant Pulmonology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Roland Lee
- Department of Nephrology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Tse-Ling Fong
- Division of Gastrointestinal and Liver Diseases, Keck School of Medicine, University of Southern California, Los Angeles, CA
- Liver Program, Hoag Digestive Health Institute, Hoag Memorial Hospital Presbyterian, Newport Beach, CA
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Tobudic S, Uyanik-Ünal K, Koblischke M, Schneider L, Blüml S, Winkler F, Haslacher H, Perkmann T, Burgmann H, Aberle JH, Winkler S. Immune response after mRNA COVID-19 vaccination in heart transplant recipients: long-term follow-up and evaluation of a third vaccination. Eur J Prev Cardiol 2022; 30:zwac231. [PMID: 36200302 PMCID: PMC9619585 DOI: 10.1093/eurjpc/zwac231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 09/30/2022] [Accepted: 10/04/2022] [Indexed: 11/25/2022]
Affiliation(s)
- Selma Tobudic
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University Vienna, Austria
| | - Keziban Uyanik-Ünal
- Clinical Division of Cardiac Surgery, Department of Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Lisa Schneider
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University Vienna, Austria
| | - Stephan Blüml
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Florian Winkler
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University Vienna, Austria
- Division of Rheumatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Helmuth Haslacher
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Thomas Perkmann
- Department of Laboratory Medicine, Medical University of Vienna, Vienna, Austria
| | - Heinz Burgmann
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University Vienna, Austria
| | - Judith H Aberle
- Center for Virology, Medical University of Vienna, Vienna, Austria
| | - Stefan Winkler
- Division of Infectious Diseases, Department of Internal Medicine I, Medical University Vienna, Austria
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Characteristics and outcomes of COVID-19 in heart transplantation recipients in the Netherlands. Neth Heart J 2022; 30:519-525. [PMID: 36074336 PMCID: PMC9454385 DOI: 10.1007/s12471-022-01720-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Immunocompromised patients are at high risk of complicated severe acute respiratory coronavirus 2 infection. The aim of this retrospective study was to describe the characteristics and outcomes of heart transplantation (HTx) recipients with coronavirus disease 2019 (COVID-19) in the Netherlands. METHODS HTx patients from one of the three HTx centres in the Netherlands with COVID-19 (proven by positive reverse-transcription polymerase chain reaction or serology test result) between February 2020 and June 2021 were included. The primary endpoint was all-cause mortality and the secondary endpoint was disease severity. RESULTS COVID-19 was diagnosed in 54/665 HTx patients (8%), with a mean (± standard deviation (SD)) time after HTx of 11 ± 8 years. Mean (± SD) age was 53 ± 14 years and 39% were female. Immunosuppressive therapy dosage was reduced in 37% patients (20/54). Hospitalisation was required in 39% patients (21/54), and 13% patients (7/54) had severe COVID-19 (leading to intensive care unit (ICU) admission or death). In-hospital mortality was 14% (3/21), and all-cause mortality was 6%. Compared with patients with moderate COVID-19 (hospitalised without ICU indication), severe COVID-19 patients tended to be transplanted earlier and had a significantly higher mean (± SD) body mass index (26 ± 3 vs 30 ± 3 kg/m2, p = 0.01). Myocardial infarction, cellular rejection and pulmonary embolism were observed once in three different HTx patients. CONCLUSION HTx patients were at increased risk of complicated COVID-19 with frequent hospitalisation, but the all-cause mortality was substantially lower than previously described (7-33%).
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12
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Oehler D, Bruno RR, Holst HT, Tudorache I, Aubin H, Sigetti D, Horn P, Akhyari P, Kelm M, Lichtenberg A, Westenfeld R, Boeken U. COVID-19 nach Herztransplantation: Erfahrungen eines deutschen Transplantationszentrums. ZEITSCHRIFT FUR HERZ THORAX UND GEFASSCHIRURGIE 2022; 36:406-413. [PMID: 35875599 PMCID: PMC9297270 DOI: 10.1007/s00398-022-00529-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/11/2022] [Accepted: 04/12/2022] [Indexed: 12/15/2022]
Abstract
Hintergrund Die durch SARS-CoV‑2 (Severe acute respiratory syndrome coronavirus type 2) verursachte Erkrankung gilt bei immunsupprimierten Patienten als besonders gefährlich. Patienten nach einer Herztransplantation zählen zu den Gruppen mit langjähriger, meist 3‑facher Immunsuppression. In der Literatur werden schwerwiegende klinische Verläufe beschrieben. Ziel der Arbeit (Fragestellung) In dieser Arbeit wird über unsere Erfahrungen mit COVID-19 (coronavirus disease 2019) bei herztransplantierten Patienten an einem deutschen Transplantationszentrum longitudinal über die bisherigen Pandemiewellen berichtet und es erfolgt eine Einordnung dieser in publizierte Erfahrungen anderer Zentren. Material und Methoden Alle adulten herztransplantierten Patienten unseres Zentrums, bei denen nach der Herztransplantation eine SARS-CoV-2-Infektion nachgewiesen wurde (n = 12), wurden eingeschlossen und retrospektiv analysiert. Ergebnisse Das Durchschnittsalter betrug 61,5 (49 bis 63) Jahre; die Mehrheit der Patienten war männlich (83 %). Die häufigsten Komorbiditäten waren Diabetes (42 %), arterielle Hypertonie (43 %) sowie chronische Niereninsuffizienz (67 %). Bei 50 % erfolgte bei Krankenhausaufnahme eine passive Immunisierung (Rekonvaleszenzplasma/monoklonale Antikörper). Eine Sauerstoffgabe war bei 33 % der Patienten notwendig; nur ein Patient erhielt eine nichtinvasive Ventilation (8 %). Kein Patient benötigte eine invasive Beatmung oder eine mechanische Herz-Kreislauf-Unterstützung (ECMO). Es fanden sich keine neuen kardiovaskulären oder thrombembolischen Ereignisse. Zusammenfassung In dieser Kohorte konnten wir longitudinal keine schweren Verläufe oder eine erhöhte Mortalität von COVID-19 in herztransplantierten Patienten detektieren. Prospektive Studien sind notwendig, um in Zukunft bessere Prognoseabschätzungen bei COVID-19 in (herz-)transplantierten Patienten treffen zu können.
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Affiliation(s)
- Daniel Oehler
- Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - Raphael Romano Bruno
- Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - Hans Torulv Holst
- Klinik für Herzchirurgie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - Igor Tudorache
- Klinik für Herzchirurgie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - Hug Aubin
- Klinik für Herzchirurgie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - Dennis Sigetti
- Klinik für Herzchirurgie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - Patrick Horn
- Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - Payam Akhyari
- Klinik für Herzchirurgie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - Malte Kelm
- Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - Artur Lichtenberg
- Klinik für Herzchirurgie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - Ralf Westenfeld
- Klinik für Kardiologie, Pneumologie und Angiologie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - Udo Boeken
- Klinik für Herzchirurgie, Medizinische Fakultät, Heinrich-Heine-Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
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13
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Peled Y, Patel JK, Afek A, Mandelboim M. Kinetics of cellular and humoral responses to third BNT162B2 COVID-19 vaccine over six months in heart transplant recipients - implications for the omicron variant: Correspondence. J Heart Lung Transplant 2022; 41:1649-1650. [PMID: 35961828 PMCID: PMC9303061 DOI: 10.1016/j.healun.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 07/14/2022] [Indexed: 11/26/2022] Open
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Degarege A, Naveed Z, Kabayundo J, Brett-Major D. Heterogeneity and Risk of Bias in Studies Examining Risk Factors for Severe Illness and Death in COVID-19: A Systematic Review and Meta-Analysis. Pathogens 2022; 11:563. [PMID: 35631084 PMCID: PMC9147100 DOI: 10.3390/pathogens11050563] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 02/07/2023] Open
Abstract
This systematic review and meta-analysis synthesized the evidence on the impacts of demographics and comorbidities on the clinical outcomes of COVID-19, as well as the sources of the heterogeneity and publication bias of the relevant studies. Two authors independently searched the literature from PubMed, Embase, Cochrane library, and CINAHL on 18 May 2021; removed duplicates; screened the titles, abstracts, and full texts by using criteria; and extracted data from the eligible articles. The variations among the studies were examined by using Cochrane, Q.; I2, and meta-regression. Out of 11,975 articles that were obtained from the databases and screened, 559 studies were abstracted, and then, where appropriate, were analyzed by meta-analysis (n = 542). COVID-19-related severe illness, admission to the ICU, and death were significantly correlated with comorbidities, male sex, and an age older than 60 or 65 years, although high heterogeneity was present in the pooled estimates. The study design, the study country, the sample size, and the year of publication contributed to this. There was publication bias among the studies that compared the odds of COVID-19-related deaths, severe illness, and admission to the ICU on the basis of the comorbidity status. While an older age and chronic diseases were shown to increase the risk of developing severe illness, admission to the ICU, and death among the COVID-19 patients in our analysis, a marked heterogeneity was present when linking the specific risks with the outcomes.
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Affiliation(s)
- Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA; (Z.N.); (J.K.); (D.B.-M.)
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15
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Kuczaj A, Przybyłowski P. Patients After Orthotopic Heart Transplantation With COVID-19: Are We Fast Enough With Vaccinations? Transplant Proc 2022; 54:897-900. [PMID: 35414424 PMCID: PMC8920909 DOI: 10.1016/j.transproceed.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/13/2022] [Accepted: 02/17/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Patients after orthotopic heart transplantation (HTx) are especially susceptible to infections owing to permanent need for immunosuppression. Vaccinations against COVID-19 have been available since January 2021 and are recommended in organ recipients. AIM The aim of this study was to analyze COVID-19 susceptibility and mortality in HTx and number of patients with COVID-19 previously vaccinated against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). PATIENTS AND METHODS We analyzed a whole cohort of 552 patients after HTx who were SARS-CoV-2 positive and remained under surveillance of the transplantation center during March 2020 to September 2021. RESULTS Among 552 patients after HTx, 10 were COVID-19 survivors prior to transplantation and 103 had SARS CoV-2 infection after transplantation. Mean age of patients with COVID-19 was 55.6 (±14) years, and mean time from transplantation to SARS-CoV-2 infection was 2856 (±2596) days (range, 16-9569 days; interquartile range, 397-4763 days). Among the patients who were COVID-19 positive, 15 were asymptomatic, 10 died, and 51 infections occurred in the era of vaccinations. In the group of patients who were positive for COVID-19 in 2021, 6 received only a single dose of the mRNA vaccine and 3 were vaccinated twice. Among the vaccinated patients with COVID-19, 2 died of severe COVID-19: 1 after a single dose and 1 after 2 standard doses of the vaccine. CONCLUSION We observed high susceptibility to SARS-CoV-2 infection in the group of patients after HTx. The majority of patients infected in 2021 did not received the vaccine. Vaccination does not fully protect against severe COVID-19 in patients after HTx.
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Affiliation(s)
- Agnieszka Kuczaj
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland; Department of Cardiac Transplantation and Mechanical Circulatory Support, Silesian Center for Heart Diseases, Zabrze, Poland.
| | - Piotr Przybyłowski
- Department of Cardiac, Vascular and Endovascular Surgery and Transplantology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland; Department of Cardiac Transplantation and Mechanical Circulatory Support, Silesian Center for Heart Diseases, Zabrze, Poland
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16
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Characteristics and Outcomes of Heart Transplant Recipients With Coronavirus-19 Disease in a High-volume Transplant Center. Transplantation 2022; 106:641-647. [PMID: 33756548 PMCID: PMC8862677 DOI: 10.1097/tp.0000000000003770] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Heart transplant (HT) recipients may be at higher risk of acquiring SARS-CoV-2 infection and developing critical illness. The aim of this study is to describe characteristics and outcomes of HT recipients infected by SARS-COV-2, from a high-volume transplant center. METHODS We have described data of all adult HT recipients with confirmed coronavirus disease 2019 by RT-PCR in nasopharyngeal samples from April 5, 2020, to January 5, 2021. Outcomes and follow-up were recorded until February 5, 2021. RESULTS Forty patients were included. Twenty-four patients (60%) were men; the median age was 53 (40-60) y old; median HT time was 34 mo; and median follow-up time 162 d. The majority needed hospitalization (83%). Immunosuppressive therapy was reduced/withdrawn in the majority of patients, except from steroids, which were maintained. Seventeen patients (42.5%) were classified as having severe disease according to the ordinal scale developed by the World Health Organization Committee. They tended to have lower absolute lymphocyte count (P < 0.001) during follow-up when compared with patients with mild disease. Thirty-day mortality was 12.5%. However, a longer follow-up revealed increased later mortality (27.5%), with median time to death around 35 d. Bacterial nosocomial infections were a leading cause of death. Cardiac allograft rejection (10%) and ventricular dysfunction (12.5%) were also not negligible. CONCLUSIONS Major findings of this study corroborate other cohorts' results, but it also reports significant rate of later events, suggesting that a strict midterm surveillance is advisable to HT recipients with coronavirus disease 2019.
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17
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Scolari FL, Hastenteufel LCT, Einsfeld L, Bueno J, Orlandin L, Clausell N, Goldraich LA. Impact of COVID-19 Infection Among Heart Transplant Recipients: A Southern Brazilian Experience. Front Med (Lausanne) 2022; 9:814952. [PMID: 35223912 PMCID: PMC8863584 DOI: 10.3389/fmed.2022.814952] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 01/04/2022] [Indexed: 11/24/2022] Open
Abstract
Purpose The coronavirus-2019 (COVID-19) infection is associated with a high risk of complications and death among heart transplant recipients. However, most cohorts are from high-income countries, while data from Latin America are sparse. Methods This is a retrospective cohort of heart transplant recipients followed at a hospital in Rio Grande do Sul, Brazil, between March 1st 2020 and October 1st 2021. Results Of the 62 heart transplant recipients on follow-up, 21 (34%) were infected by COVID-19, 58 (36–63) years of age, 67% male, body mass index of 26 (23-29) kg/m2, 48% with hypertension, 43% with chronic kidney disease, 5% with diabetes, within 2 (1–4) years of post-transplant follow-up. At presentation, the main symptoms were fever (62%), myalgia (33%), cough (33%), headache (33%), and dyspnea (19%). Hospitalization was required for 13 (62%) patients, with a time from first symptoms to the admission of 5 (1–12) days. In 38%, supplementary oxygen was needed, 19% required intensive care, and 10% mechanical ventilation. Three (14%) were infected after at least a first dose of COVID-19 vaccine. The main complications were bacterial pneumonia (38%), renal replacement therapy (19%), sepsis (10%) and venous thromboembolism (10%). Immunosuppression therapy was modified in 48%, with a reduction in the majority (89%). Two (10%) patients died in the hospital due to refractory hypoxemia and multiple organ dysfunction. The incidence of COVID-19 among transplant patients was comparable to the general population in the State of Rio Grande do Sul with a peak in December 2020. Conclusion Heart transplant recipients shown a high rate of COVID-19 infection in Southern Brazil, with typical symptom presentation in most cases. There was an elevated rate of hospitalization, supplementary oxygen support, and complications. In-hospital lethality among infected heart transplanted recipients was similar to previously reported data worldwide despite the high rates of infection in Latin America.
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Affiliation(s)
- Fernando Luis Scolari
- Heart Transplant Program, Division of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.,Ted Rogers Center for Heart Research, Peter Munk Cardiac Center, University Health Network, Toronto, ON, Canada
| | | | - Lídia Einsfeld
- Pharmacy Service, Clinical Pharmacy Section, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Julia Bueno
- Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Letícia Orlandin
- Heart Transplant Program, Division of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
| | - Nadine Clausell
- Heart Transplant Program, Division of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.,Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Lívia Adams Goldraich
- Heart Transplant Program, Division of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil
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An W, Wang Q, Kim TE, Kang JS. Clinical characteristics and outcome of coronavirus disease 2019 infection in patients with solid organ transplants: A systematic review and meta-analysis. J Infect Public Health 2022; 15:365-372. [PMID: 35193818 PMCID: PMC8857642 DOI: 10.1016/j.jiph.2022.02.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/03/2022] [Accepted: 02/06/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Wen An
- Department of Pharmacology & Clinical Pharmacology, College of Medicine, Hanyang University, Seoul, South Korea.
| | - Qiuyang Wang
- Department of Central China Research Institute of Health, Xinxiang Medical University, Xinxiang, China.
| | - Tae-Eun Kim
- Department of Clinical Pharmacology, Konkuk University Hospital, Seoul, South Korea.
| | - Ju-Seop Kang
- Department of Pharmacology & Clinical Pharmacology, College of Medicine, Hanyang University, Seoul, South Korea.
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19
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Zetina-Tun HJ, Careaga-Reyna G. Infección por SARS-CoV-2 en pacientes trasplantados de corazón. Experiencia en México. CIRUGIA CARDIOVASCULAR 2022. [PMCID: PMC8226102 DOI: 10.1016/j.circv.2021.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
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20
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Taghavi S, Raffiei Jelodar H, Rafati A, Naderi N, Mirtajaddini M, Amin A, Valizadeh L, Omidvar R, Kamali M, Naseh S. COVID-19 in heart transplant recipients. J Cardiovasc Thorac Res 2022; 14:258-262. [PMID: 36699553 PMCID: PMC9871157 DOI: 10.34172/jcvtr.2022.31583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 11/20/2022] [Indexed: 01/09/2023] Open
Abstract
Introduction: After solid organ transplantation, patients require lifelong immunosuppressive medication, increasing susceptibility to COVID-19. We evaluated the clinical outcomes of heart transplant recipients in patients with COVID-19. Methods: We enrolled twenty-two COVID-19 cases of adult heart transplantation from February 2020 to September 2021. Results: The most common symptoms in patients were fever and myalgia. The death occurred in 3 (13.6 %). Conclusion: Although heart transplantation mortality may increase in the acute rejection phase concomitant with COVID-19, immunosuppressive dose reduction may not be necessary for all heart transplant patients with COVID-19.
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Affiliation(s)
- Sepideh Taghavi
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Hoda Raffiei Jelodar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran,Corresponding Author: Hoda Raffiei Jelodar,
| | - Ali Rafati
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nasim Naderi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Mirtajaddini
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ahmad Amin
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Leili Valizadeh
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Razieh Omidvar
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Monireh Kamali
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Suarez-Pierre A, Choudhury R, Carroll AM, King RW, Iguidbashian J, Cotton J, Colborn KL, Kennealey PT, Cleveland JC, Pomfret E, Fullerton DA. Measuring the effect of the COVID-19 pandemic on solid organ transplantation. Am J Surg 2021; 224:437-442. [PMID: 34980465 PMCID: PMC8717917 DOI: 10.1016/j.amjsurg.2021.12.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 12/11/2021] [Accepted: 12/27/2021] [Indexed: 12/24/2022]
Abstract
Background The COVID-19 pandemic has uniquely affected the United States. We hypothesize that transplantation would be uniquely affected. Methods In this population-based cohort study, adult transplantation data were examined as time series data. Autoregressive-integrated-moving-average models of transplantation rates were developed using data from 1990 to 2019 to forecast the 2020 expected rates in a theoretical scenario if the pandemic did not occur to generate observed-to-expected (O/E) ratios. Results 32,594 transplants were expected in 2020, and only 30,566 occurred (O/E 0.94, CI 0.88–0.99). 58,152 waitlist registrations were expected and 50,241 occurred (O/E 0.86, CI 0.80–0.94). O/E ratios of transplants were kidney 0.92 (0.86–0.98), liver 0.96 (0.89–1.04), heart 1.05 (0.91–1.23), and lung 0.92 (0.82–1.04). O/E ratios of registrations were kidney 0.84 (0.77–0.93), liver 0.95 (0.86–1.06), heart 0.99 (0.85–1.18), and lung 0.80 (0.70–0.94). Conclusions The COVID-19 pandemic was associated with a significant deficit in transplantation. The impact was strongest in kidney transplantation and waitlist registration.
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Affiliation(s)
| | - Rashikh Choudhury
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Adam M Carroll
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert W King
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - John Iguidbashian
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jake Cotton
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Kathryn L Colborn
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Peter T Kennealey
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Joseph C Cleveland
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - Elizabeth Pomfret
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - David A Fullerton
- Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
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22
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Dakroub F, Fakhredine S, Yassine M, Dayekh A, Jaber R, Fadel A, Akl H, Maatouk A. A retrospective analysis of 902 hospitalized COVID‐19 patients in Lebanon: clinical epidemiology and risk factors. JOURNAL OF CLINICAL VIROLOGY PLUS 2021; 1:100048. [PMID: 35262028 PMCID: PMC8532499 DOI: 10.1016/j.jcvp.2021.100048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 12/23/2022] Open
Abstract
Background: The clinical epidemiology of hospitalized COVID-19 patients has never been described before in Lebanon. Moreover, the hospital admission and PCR positivity rates have not been assessed and compared yet. Objectives: To describe the characteristics and outcomes of hospitalized patients with coronavirus induced disease 2019 (COVID-19) in Lebanon and identify risk factors for severe disease or death. Study design: This is a retrospective mono-center cohort study in which we used patients’ files to extract and analyse data on demographic and clinical characteristics, as well as mortality. Moreover, we tracked the pandemic by recording the daily total and ICU inpatient census and the PCR positivity rate for admitted and outpatients. Results: Although the total admission rate increased from September to April, the ICU census switched this trend in December to stabilize at an average of around 10 patients/day until April. The case fatality rate was 19% for the 902 hospitalized patients, of which the majority (80%) had severe COVID-19. The severity odds ratio is significantly decreased in immunosuppressed cases (OR, 0.18; CI, 0.05-0.67; p=0.011). Additionally, the odds of COVID-19 related death are significantly greater if consolidations are found in the chest computed tomography (CT) scan (OR, 12; CI, 2.63-55.08; p=0.0013). Conclusion: Consolidations in the lungs significantly increase the COVID-19 death risk. Risk factors identification is important to improve patients’ management and vaccination strategies. In addition, hospital statistics are good indicators of a pandemic's track.
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Affiliation(s)
- Fatima Dakroub
- Research unit, Saint George Hospital, Lebanon
- Biology Department, Faculty of Sciences-I, Lebanese University, Lebanon
| | - Suha Fakhredine
- Research unit, Saint George Hospital, Lebanon
- Infectious diseases division, Saint George Hospital, Lebanon
| | - Mohammad Yassine
- Research unit, Saint George Hospital, Lebanon
- Pharmacy Department, Saint George Hospital, Lebanon
| | - Alaa Dayekh
- Research unit, Saint George Hospital, Lebanon
- Quality Improvement Department, Saint George Hospital, Lebanon
| | - Rachid Jaber
- Faculty of Medicine, Lebanese University, Lebanon
| | - Abbass Fadel
- Infectious diseases division, Saint George Hospital, Lebanon
| | - Haidar Akl
- Biology Department, Faculty of Sciences-I, Lebanese University, Lebanon
| | - Ali Maatouk
- The pulmonary department, Saint George Hospital, Lebanon
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23
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Herrera S, Colmenero J, Pascal M, Escobedo M, Castel MA, Sole-González E, Palou E, Egri N, Ruiz P, Mosquera M, Moreno A, Juan M, Vilella A, Soriano A, Farrero M, Bodro M. Cellular and humoral immune response after mRNA-1273 SARS-CoV-2 vaccine in liver and heart transplant recipients. Am J Transplant 2021; 21:3971-3979. [PMID: 34291552 PMCID: PMC9800111 DOI: 10.1111/ajt.16768] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/02/2021] [Accepted: 07/17/2021] [Indexed: 01/25/2023]
Abstract
Recently published studies have found an impaired immune response after SARS-CoV-2 vaccination in solid organ recipients. However, most of these studies have not assessed immune cellular responses in liver and heart transplant recipients. We prospectively studied heart and liver transplant recipients eligible for SARS-CoV-2 vaccination. Patients with past history of SARS-CoV-2 infection or SARS-CoV-2 detectable antibodies (IgM or IgG) were excluded. We assessed IgM/IgG antibodies and ELISpot against the S protein 4 weeks after receiving the second dose of the mRNA-1273 (Moderna) vaccine. Side effects, troponin I, liver tests and anti-HLA donor-specific antibodies (DSA) were also assessed. A total of 58 liver and 46 heart recipients received two doses of mRNA-1273 vaccine. Median time from transplantation to vaccination was 5.4 years (IQR 0.3-27). Sixty-four percent of the patients developed SARS-CoV-2 IgM/IgG antibodies and 79% S-ELISpot positivity. Ninety percent of recipients developed either humoral or cellular response (87% in heart recipients and 93% in liver recipients). Factors associated with vaccine unresponsiveness were hypogammaglobulinemia and vaccination during the first year after transplantation. Local and systemic side effects were mild or moderate, and none presented DSA or graft dysfunction after vaccination. Ninety percent of our patients did develop humoral or cellular responses to mRNA-1273 vaccine. Factors associated with vaccine unresponsiveness were hypogammaglobulinemia and vaccination during the first year after transplantation, highlighting the need to further protect these patients.
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Affiliation(s)
- Sabina Herrera
- Department of Infectious Diseases, Hospital Clínic, University of Barcelonae, Barcelona, Spain
| | - Jordi Colmenero
- Liver Transplantation, Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Mariona Pascal
- Department of Immunology, CDB, Hospital Clínic, Barcelona, Spain,Immunoal·lergia Clínica Respiratoria i Experimental (IRCE), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Red Nacional de Alergia, Asma, Reacciones Adversas y Alérgicas (ARADyAL), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Miguel Escobedo
- Liver Transplantation, Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - María A. Castel
- Unit for Heart Failure and Heart Transplantation, Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - Eduard Sole-González
- Unit for Heart Failure and Heart Transplantation, Department of Cardiology, Hospital Clínic, Barcelona, Spain
| | - Eduard Palou
- Department of Immunology, CDB, Hospital Clínic, Barcelona, Spain,Immunoal·lergia Clínica Respiratoria i Experimental (IRCE), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Red Nacional de Alergia, Asma, Reacciones Adversas y Alérgicas (ARADyAL), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Natalia Egri
- Department of Immunology, CDB, Hospital Clínic, Barcelona, Spain
| | - Pablo Ruiz
- Liver Transplantation, Liver Unit, Hospital Clínic, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Mar Mosquera
- Department of Microbiology, Hospital Clínic, Barcelona, Spain
| | - Asunción Moreno
- Department of Infectious Diseases, Hospital Clínic, University of Barcelonae, Barcelona, Spain
| | - Manel Juan
- Department of Immunology, CDB, Hospital Clínic, Barcelona, Spain,Immunoal·lergia Clínica Respiratoria i Experimental (IRCE), Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain,Red Nacional de Alergia, Asma, Reacciones Adversas y Alérgicas (ARADyAL), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Anna Vilella
- Department of Preventive Medicine and Epidemiology, Hospital Clinic, University of barcelonae, Barcelona, Spain
| | - Alex Soriano
- Department of Infectious Diseases, Hospital Clínic, University of Barcelonae, Barcelona, Spain
| | - Marta Farrero
- Unit for Heart Failure and Heart Transplantation, Department of Cardiology, Hospital Clínic, Barcelona, Spain,Correspondence Marta Bodro and Marta Farrero, Department of Infectious Diseases and Unit for Heart Failure and Heart Transplantation, Hospital Clínic of Barcelona, Carrer Villarroel, Barcelona, Spain. (M. B.) and (M. F.)
| | - Marta Bodro
- Department of Infectious Diseases, Hospital Clínic, University of Barcelonae, Barcelona, Spain,Correspondence Marta Bodro and Marta Farrero, Department of Infectious Diseases and Unit for Heart Failure and Heart Transplantation, Hospital Clínic of Barcelona, Carrer Villarroel, Barcelona, Spain. (M. B.) and (M. F.)
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24
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Melhaoui I, Oujidi Y, El Heddad IA, Bensaid A, Bkiyar H, Bentata Y, Housni B. Management of post cardiac transplantation immunosuppression and COVID-19: A case report. Ann Med Surg (Lond) 2021; 71:102875. [PMID: 34567547 PMCID: PMC8452461 DOI: 10.1016/j.amsu.2021.102875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND There is very limited experience in management of heart transplant (HT) recipients and their immunosuppressive drug therapies while confronted with a SARS-CoV-2 infection. CASE DETAILS We report the case of a 60-year-old male, heart transplant recipient patient, admitted in our ICU for severe COVID-19. His immunosuppressors were discontinued. He presented an ARDS, a multiple organ failure and a refractory septic shock that eventually resulted in his death. DISCUSSION Multiple studies reported a lower incidence of SARS-Cov-2 infection in HT recipients compared to the general population, probably due to their prior knowledge and use of protective and barrier measures; but when infected they tend to have poorer outcomes and higher fatality; on account of their pre-existing comorbidities and immunodeficiency. Therefore, the management of the immunosuppressive therapy raises a challenge, in the absence of trials. Physicians rely on experts' recommendations, to maintain the immunosuppressors in case of mild COVID-19, lower to the bare minimum or even discontinue them in case of critical COVID-19 or systemic complications. CONCLUSION COVID-19 infection is associated with poor outcomes and high mortality in HT recipients, and their immunosuppressive therapy management still raises questions and challenges in the absence of trial-validated data.
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Affiliation(s)
- Imane Melhaoui
- Nephrology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Younes Oujidi
- Anaesthesia and Resuscitation Service – Hospital University Mohammed VI of Oujda. Oujda Faculty of Medicine and Pharmacy, Mohammed Premier University, Oujda, Morocco
| | - Inass Arhoun El Heddad
- Anaesthesia and Resuscitation Service – Hospital University Mohammed VI of Oujda. Oujda Faculty of Medicine and Pharmacy, Mohammed Premier University, Oujda, Morocco
| | - Amine Bensaid
- Anaesthesia and Resuscitation Service – Hospital University Mohammed VI of Oujda. Oujda Faculty of Medicine and Pharmacy, Mohammed Premier University, Oujda, Morocco
| | - Houssam Bkiyar
- Anaesthesia and Resuscitation Service – Hospital University Mohammed VI of Oujda. Oujda Faculty of Medicine and Pharmacy, Mohammed Premier University, Oujda, Morocco
| | - Yassamine Bentata
- Nephrology Department, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Oujda, Morocco
| | - Brahim Housni
- Anaesthesia and Resuscitation Service – Hospital University Mohammed VI of Oujda. Oujda Faculty of Medicine and Pharmacy, Mohammed Premier University, Oujda, Morocco
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25
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Ito T, Kenmochi T, Ota A, Kuramitsu K, Soyama A, Kinoshita O, Eguchi S, Yuzawa K, Egawa H. National survey on deceased donor organ transplantation during the COVID-19 pandemic in Japan. Surg Today 2021; 52:763-773. [PMID: 34686930 PMCID: PMC8536472 DOI: 10.1007/s00595-021-02388-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 08/11/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE We investigated the status of deceased organ donation and transplantation through a questionnaire distributed to transplant centers in Japan during the COVID-19 pandemic. METHODS The questionnaire was distributed electronically to 206 transplant centers for heart (n = 11), lung (n = 10), liver (n = 25), kidney (n = 130), pancreas (n = 18), and small intestine (n = 12) transplantation. Organ donations and organ transplantation data were extracted from the Japan Organ Transplant Network website. RESULTS We received questionnaire responses from 177 centers (response rate, 86%). In 2020, the number of brain-dead donors (BDDs) decreased to 68 (69% of the year-on-year average) and the number of donors after cardiac death (DCDs) decreased to 9 (32% of the year-on-year average). Eighty-five (48%) transplant centers (heart, n = 0; lung, n = 0; liver, n = 4; kidney, n = 78; pancreas, n = 22; and small intestine, n = 0) suspended transplant surgeries in response to the COVID-19 pandemic. Consequently, the number of organ transplantations from deceased donors was significantly lower in 2020 than in 2019. CONCLUSION Although the COVID-19 pandemic has had less impact in Japan than in other countries, it has affected transplantation activity significantly, suspending transplantation surgeries in 48% of the transplantation centers, including 78% of the kidney transplantation centers, and reducing the number of organ donations to 61% of the year-on-year average.
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Affiliation(s)
- Taihei Ito
- Department of Transplantation and Regenerative Medicine, Fujita Health University, School of Medicine, Dengakugakubo 1-98, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan.
| | - Takashi Kenmochi
- Department of Transplantation and Regenerative Medicine, Fujita Health University, School of Medicine, Dengakugakubo 1-98, Kutsukakecho, Toyoake, Aichi, 470-1192, Japan
| | - Atsuhiko Ota
- Department of Public Health, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
| | - Kaori Kuramitsu
- Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Akihiko Soyama
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Osamu Kinoshita
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo, Tokyo, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Nagasaki, Japan
| | - Kenji Yuzawa
- Department of Transplantation Surgery, National Hospital Organization Mito Medical Center, Mito, Ibaraki, Japan
| | - Hiroto Egawa
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku, Tokyo, Japan
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26
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Rosano G, Jankowska EA, Ray R, Metra M, Abdelhamid M, Adamopoulos S, Anker SD, Bayes‐Genis A, Belenkov Y, Gal TB, Böhm M, Chioncel O, Cohen‐Solal A, Farmakis D, Filippatos G, González A, Gustafsson F, Hill L, Jaarsma T, Jouhra F, Lainscak M, Lambrinou E, Lopatin Y, Lund LH, Milicic D, Moura B, Mullens W, Piepoli MF, Ponikowski P, Rakisheva A, Ristic A, Savarese G, Seferovic P, Senni M, Thum T, Tocchetti CG, Van Linthout S, Volterrani M, Coats AJ. COVID-19 vaccination in patients with heart failure: a position paper of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2021; 23:1806-1818. [PMID: 34612556 PMCID: PMC8652673 DOI: 10.1002/ejhf.2356] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2021] [Revised: 09/08/2021] [Accepted: 09/28/2021] [Indexed: 01/19/2023] Open
Abstract
Patients with heart failure (HF) who contract SARS‐CoV‐2 infection are at a higher risk of cardiovascular and non‐cardiovascular morbidity and mortality. Regardless of therapeutic attempts in COVID‐19, vaccination remains the most promising global approach at present for controlling this disease. There are several concerns and misconceptions regarding the clinical indications, optimal mode of delivery, safety and efficacy of COVID‐19 vaccines for patients with HF. This document provides guidance to all healthcare professionals regarding the implementation of a COVID‐19 vaccination scheme in patients with HF. COVID‐19 vaccination is indicated in all patients with HF, including those who are immunocompromised (e.g. after heart transplantation receiving immunosuppressive therapy) and with frailty syndrome. It is preferable to vaccinate against COVID‐19 patients with HF in an optimal clinical state, which would include clinical stability, adequate hydration and nutrition, optimized treatment of HF and other comorbidities (including iron deficiency), but corrective measures should not be allowed to delay vaccination. Patients with HF who have been vaccinated against COVID‐19 need to continue precautionary measures, including the use of facemasks, hand hygiene and social distancing. Knowledge on strategies preventing SARS‐CoV‐2 infection (including the COVID‐19 vaccination) should be included in the comprehensive educational programmes delivered to patients with HF.
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Affiliation(s)
| | - Ewa A. Jankowska
- Institute of Heart DiseasesWrocław Medical UniversityWrocławPoland
| | - Robin Ray
- Cardiology Clinical Academic GroupMolecular and Clinical Sciences Research Institute, St George's, University of London, St George's HospitalLondonUK
| | - Marco Metra
- Institute of CardiologyASST Spedali Civili di Brescia and Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of BresciaBresciaItaly
| | - Magdy Abdelhamid
- Faculty of Medicine, Kasr Al Ainy, Department of CardiologyCairo UniversityGizaEgypt
| | - Stamatis Adamopoulos
- Heart Failure ‐ Transplant ‐ Mechanical Circulatory Support UnitOnassis Cardiac Surgery CenterAthensGreece
| | - Stefan D. Anker
- Department of Cardiology (CVK)and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité UniversitätsmedizinBerlinGermany
| | - Antoni Bayes‐Genis
- Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona & CIBERCV, Instituto de Salud Carlos IIIMadridSpain
| | - Yury Belenkov
- I.M. Sechenov First Moscow State Medical University (Sechenov University)MoscowRussia
| | - Tuvia B. Gal
- Department of Cardiology, Rabin Medical CenterPetah Tikva, Israel, & Sackler Faculty of Medicine, Tel Aviv UniversityTel AvivIsrael
| | - Michael Böhm
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Saarland University, Kardiologie, Angiologie und Internistische IntensivmedizinHomburg/SaarGermany
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases ‘Prof. C.C. Iliescu’, University of Medicine Carol DavilaBucharestRomania
| | - Alain Cohen‐Solal
- UMR‐S 942 Research UnitParis University, Lariboisiere Hospital, Cardiology Department, AP‐HPParisFrance
| | | | - Gerasimos Filippatos
- National and Kapodistrian University of Athens, School of Medicine, University Hospital AttikonAthensGreece
| | - Arantxa González
- Program of Cardiovascular Diseases, CIMA Universidad de Navarra, IdiSNA and CIBERCVPamplonaSpain
| | - Finn Gustafsson
- Department of CardiologyUniversity of CopenhagenCopenhagenDenmark
| | - Loreena Hill
- School of Nursing & Midwifery, Queen's University, BelfastNorthern IrelandUK
| | - Tiny Jaarsma
- Department of Health, Medicine and Caring Sciences, Linköping UniversityLinköpingSweden
| | - Fadi Jouhra
- Cardiology Clinical Academic GroupMolecular and Clinical Sciences Research Institute, St George's, University of London, St George's HospitalLondonUK
| | - Mitja Lainscak
- Division of CardiologyGeneral Hospital Murska Sobota, Murska Sobota, Slovenia, & Faculty of Medicine, University of LjubljanaLjubljanaSlovenia
| | - Ekaterini Lambrinou
- Department of NursingSchool of Health Sciences, Cyprus University of TechnologyLimassolCyprus
| | - Yury Lopatin
- Volgograd State Medical University, Regional Cardiology CentreVolgogradRussian Federation
| | - Lars H. Lund
- Department of MedicineKarolinska Institutet, and Heart and Vascular Theme, Karolinska University HospitalStockholmSweden
| | - Davor Milicic
- University of Zagreb School of MedicineZagrebCroatia
| | - Brenda Moura
- Armed Forces Hospital, Porto, & Faculty of Medicine, University of PortoPortoPortugal
| | - Wilfried Mullens
- Cardiovascular Physiology, Hasselt University, Belgium, & Heart Failure and Cardiac Rehabilitation Specialist, Ziekenhuis Oost‐LimburgGenkBelgium
| | - Massimo F. Piepoli
- Cardiac UnitGuglielmo da Saliceto Hospital, University of ParmaPiacenzaItaly
| | - Piotr Ponikowski
- Institute of Heart DiseasesWrocław Medical UniversityWrocławPoland
| | - Amina Rakisheva
- Department of CardiologyScientific Institution of Cardiology and Internal DiseasesAlmatyKazakhstan
| | - Arsen Ristic
- Department of CardiologyUniversity Clinical Center of Serbia, Belgrade University School of MedicineBelgradeSerbia
| | - Gianluigi Savarese
- Department of MedicineKarolinska Institutet, and Heart and Vascular Theme, Karolinska University HospitalStockholmSweden
| | - Petar Seferovic
- Department Faculty of MedicineUniversity of Belgrade, Belgrade & Serbian Academy of Sciences and ArtsBelgradeSerbia
| | - Michele Senni
- Cardiovascular Department, Cardiology 1 UnitPapa Giovanni XXIII Hospital Bergamo, University of Milano ‐ BicoccaBergamoItaly
| | - Thomas Thum
- Institute of Molecular and Therapeutic Strategies, Hannover & Fraunhofer Institute of Toxicology and Experimental MedicineHannoverGermany
| | - Carlo G. Tocchetti
- Department of Translational Medical Sciences, Center for Basic and Clinical Immunology Research (CISI), Interdepartmental Center of Clinical and Translational Sciences (CIRCET)Interdepartmental Hypertension Research Center (CIRIAPA), Federico II UniversityNaplesItaly
| | - Sophie Van Linthout
- Berlin Institute of Health at Charité ‐ Universitätmedizin Berlin, BIH Center for Regenerative Therapies, Berlin, German Center for Cardiovascular Research (DZHK), Partner site BerlinBerlinGermany
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27
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Quante M, Brake L, Tolios A, Della Penna A, Steidle C, Gruendl M, Grishina A, Haeberle H, Guthoff M, Tullius SG, Königsrainer A, Nadalin S, Löffler MW. SARS-CoV-2 in Solid Organ Transplant Recipients: A Structured Review of 2020. Transplant Proc 2021; 53:2421-2434. [PMID: 34551880 PMCID: PMC8364801 DOI: 10.1016/j.transproceed.2021.08.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/04/2021] [Accepted: 08/10/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is challenging health systems all over the world. Particularly high-risk groups show considerable mortality rates after infection. In 2020, a huge number of case reports, case series, and consecutively various systematic reviews have been published reporting on morbidity and mortality risk connected with SARS-CoV-2 in solid organ transplant (SOT) recipients. However, this vast array of publications resulted in an increasing complexity of the field, overwhelming even for the expert reader. METHODS We performed a structured literature review comprising electronic databases, transplant journals, and literature from previous systematic reviews covering the entire year 2020. From 164 included articles, we identified 3451 cases of SARS-CoV-2-infected SOT recipients. RESULTS Infections resulted in a hospitalization rate of 84% and 24% intensive care unit admissions in the included patients. Whereas 53.6% of patients were reported to have recovered, cross-sectional overall mortality reported after coronavirus disease 2019 (COVID-19) was at 21.1%. Synoptic data concerning immunosuppressive medication attested to the reduction or withdrawal of antimetabolites (81.9%) and calcineurin inhibitors (48.9%) as a frequent adjustment. In contrast, steroids were reported to be increased in 46.8% of SOT recipients. CONCLUSIONS COVID-19 in SOT recipients is associated with high morbidity and mortality worldwide. Conforming with current guidelines, modifications of immunosuppressive therapies mostly comprised a reduction or withdrawal of antimetabolites and calcineurin inhibitors, while frequently maintaining or even increasing steroids. Here, we provide an accessible overview to the topic and synoptic estimates of expectable outcomes regarding in-hospital mortality of SOT recipients with COVID-19.
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Affiliation(s)
- Markus Quante
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Linda Brake
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Alexander Tolios
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria; Center for Physiology and Pharmacology, Institute of Vascular Biology and Thrombosis Research, Medical University of Vienna, Vienna, Austria; Center for Medical Statistics, Informatics, and Intelligent Systems, Institute of Artificial Intelligence, Medical University of Vienna, Vienna, Austria
| | - Andrea Della Penna
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Christoph Steidle
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Magdalena Gruendl
- Department of Epidemiology, Technical University Munich, Munich, Germany
| | - Anna Grishina
- Department of Pediatrics I, University Medicine Essen, Essen, Germany
| | - Helene Haeberle
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Tübingen, Germany
| | - Martina Guthoff
- Department of Diabetology, Endocrinology, Nephrology, Section of Nephrology and Hypertension, University Hospital Tübingen, Tübingen, Germany; Institute for Diabetes Research and Metabolic Diseases of the Helmholtz Center Munich, University of Tübingen, Tübingen, Germany; German Center for Diabetes Research (DZD e.V.), Neuherberg, Germany
| | - Stefan G Tullius
- Division of Transplant Surgery and Transplant Surgery Research Laboratory, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Alfred Königsrainer
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies," University of Tübingen, Tübingen, Germany
| | - Silvio Nadalin
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany
| | - Markus W Löffler
- Department of General, Visceral, and Transplant Surgery, University Hospital Tübingen, Tübingen, Germany; Cluster of Excellence iFIT (EXC 2180) "Image-Guided and Functionally Instructed Tumor Therapies," University of Tübingen, Tübingen, Germany; Department of Immunology, Interfaculty Institute for Cell Biology, University of Tübingen, Tübingen, Germany; Department of Clinical Pharmacology, University Hospital Tübingen, Tübingen, Germany.
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28
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Kaye AD, Spence AL, Mayerle M, Sardana N, Clay CM, Eng MR, Luedi MM, Carroll Turpin MA, Urman RD, Cornett EM. Impact of COVID-19 infection on the cardiovascular system: An evidence-based analysis of risk factors and outcomes. Best Pract Res Clin Anaesthesiol 2021; 35:437-448. [PMID: 34511231 PMCID: PMC7919539 DOI: 10.1016/j.bpa.2021.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Accepted: 02/23/2021] [Indexed: 02/09/2023]
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), also known as COVID-19, emerged in late 2019 in Wuhan, China. The World Health Organization declared the virus a pandemic on March 11, 2020. Disease progression from COVID-19 infection has shown significant symptom manifestations within organ systems beyond the respiratory system. The literature has shown increasing evidence of cardiovascular involvement during disease course and an associated increase in mortality among infected patients. Although the understanding of this novel virus is continually evolving, it is currently proposed that the mechanism by which the SARS-CoV-2 virus contributes to cardiovascular manifestations involves the ACE2 transmembrane protein. The protein ACE2 is highly expressed in blood vessel pericytes, and infection can result in microvascular dysfunction and subsequent acute coronary syndromes. Complications involving the cardiovascular system include myocardial infarction, arrhythmias, shock, and heart failure. In this evidence-based review, we discuss risk factors of cardiovascular involvement in COVID-19 infection, pathophysiology of COVID-19-related cardiovascular infection, and injury, COVID-19 effects on the cardiovascular system and corresponding treatments, and hematologic effects of COVID-19 and COVID-19 in heart transplant patients. Clinicians managing COVID-19 patients should appreciate the potential cardiovascular effects related to the disease process.
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Affiliation(s)
- Alan D. Kaye
- Department of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Allyson L. Spence
- Department of Pharmaceutical Sciences, Regis University School of Pharmacy, Denver, CO, 80221, USA
| | - Mariah Mayerle
- Regis University School of Pharmacy, Denver, CO, 80221, USA.
| | - Nitish Sardana
- Rutgers Robert Wood Johnson Medical School, 675 Hoes Ln W, Piscataway, NJ, 08854, USA.
| | - Claire M. Clay
- LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
| | - Matthew R. Eng
- Department of Anesthesiology, LSU Health Sciences Center, 1542 Tulane Avenue, New Orleans, LA, 70112, USA
| | - Markus M. Luedi
- Bern University Hospital Inselspital, University of Bern, Bern, Switzerland
| | - Michelle A. Carroll Turpin
- Department of Biomedical Sciences, College of Medicine, University of Houston, Health 2 Building, Room, 8037, USA
| | - Richard D. Urman
- Department of Anesthesiology, Perioperative and Pain Medicine, Harvard Medical School, Brigham and Women's Hospital, 75 Francis St, Boston, MA, 02115, USA,Corresponding author
| | - Elyse M. Cornett
- Department of Anesthesiology, LSU Health Shreveport, 1501 Kings Highway, Shreveport, LA, 71103, USA
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29
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Naghashzadeh F, Shafaghi S, Sharif-Kashani B, Tabarsi P, Saliminejad L, Noorali S. Coronavirus disease 2019 outcomes in heart transplant recipients: a single-center case series. J Med Case Rep 2021; 15:453. [PMID: 34511111 PMCID: PMC8435348 DOI: 10.1186/s13256-021-03028-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 07/23/2021] [Indexed: 11/18/2022] Open
Abstract
Background With the rapidly expanding pandemic of severe acute respiratory syndrome coronavirus-2, a chronic immunosuppressed state in solid organ transplant recipients is a concern. We reported coronavirus disease 2019 in heart transplant recipients and described the patients’ course from diagnosis to either hospital admission or improvement in symptoms. Case presentation This study retrospectively identified 13 white (Iranian) heart transplant patients with coronavirus disease 2019 between December 2019 and October 2020. The mean age of patients was 43.7 years (19–65 years); seven (70%) were men. Laboratory and treatment data were collected for those admitted or managed as outpatients. Outcomes were also recorded for all patients. This report demonstrates a range of symptoms, clinical severity, and disease course in heart transplant recipients with coronavirus disease 2019, including ten hospitalized patients and three patients, managed entirely in the outpatient setting. One patient passed away, and none of them experienced an episode of clinically overt rejection. Conclusions We would like to emphasize the importance of being alert in these patients to consider testing in a broad range of clinical presentations and gathering more data for better management.
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Affiliation(s)
- Farah Naghashzadeh
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Shafaghi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Sharif-Kashani
- Tobacco Prevention and Control Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Payam Tabarsi
- Infectious Disease Specialist, Fellowship of Infection in Immunocompromised Host, Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Leila Saliminejad
- Bachelor of Science in Nursing (BSN), Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sima Noorali
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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30
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Kittleson MM, Chambers DC, Cypel M, Potena L. Covid-19 in recipients of heart and lung transplantation: Learning from experience. J Heart Lung Transplant 2021; 40:948-950. [PMID: 34246563 PMCID: PMC8188768 DOI: 10.1016/j.healun.2021.05.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 05/28/2021] [Indexed: 12/23/2022] Open
Affiliation(s)
- Michelle M Kittleson
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Daniel C Chambers
- School of Clinical Medicine, The University of Queensland and Queensland Lung Transplant Program, Brisbane, Australia
| | - Marcelo Cypel
- Toronto Lung Transplant Program, University of Toronto, Toronto, Ontario, Canada
| | - Luciano Potena
- Heart Failure and Transplant Program, IRCCS Policlinico di Sant'Orsola, Bologna, Italy
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31
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Diaz‐Arocutipa C, Carvallo‐Castañeda D, Luis‐Ybañez O, Pariona M, Rivas‐Lasarte M, Álvarez‐García J. COVID-19 in heart transplant recipients during February-August 2020: A systematic review. Clin Transplant 2021; 35:e14390. [PMID: 34159650 PMCID: PMC8420345 DOI: 10.1111/ctr.14390] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/13/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic represents a major concern in immunosuppressed patients such as heart transplant recipients. Therefore, we performed a systematic review to summarize the clinical features, treatment, and outcomes of heart transplant recipients with COVID-19. We searched electronic databases from inception to January 11, 2021. Thirty-nine articles (22 case reports and 17 cohorts) involving 415 patients were included. The mean age was 59.9 ± 15.7 years and 77% of patients were men. In cohort studies including outpatients and inpatients, the hospitalization rate was 77%. The most common symptoms were fever (70%) and cough (67%). Inflammatory biomarkers (C-reactive protein and procalcitonin) were above the normal range. Forty-eight percent of patients presented with severe or critical COVID-19. Hydroxychloroquine (54%), azithromycin (14%), and lopinavir/ritonavir (14%) were the most commonly used drugs. Forty-nine percent of patients discontinued the baseline regimen of antimetabolites. In contrast, 59% and 73% continued the same regimen of calcineurin inhibitors and corticosteroids, respectively. Short-term mortality among cohorts limited to inpatients was 25%. Our review suggests that heart transplant recipients with COVID-19 exhibited similar demographic and clinical features to the general population. However, the prognosis was poor in these patients.
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Affiliation(s)
- Carlos Diaz‐Arocutipa
- Vicerrectorado de InvestigaciónUniversidad San Ignacio de LoyolaLimaPeru
- Programa de Atención Domiciliaria (PADOMI) – EsSaludLimaPeru
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS)LimaPeru
| | - Darla Carvallo‐Castañeda
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS)LimaPeru
- Puesto de Salud PacaycasaMinisterio de SaludAyacuchoPeru
| | - Odalis Luis‐Ybañez
- Asociación para el Desarrollo de la Investigación Estudiantil en Ciencias de la Salud (ADIECS)LimaPeru
- Facultad de Medicina de San FernandoUniversidad Nacional Mayor de San MarcosLimaPeru
| | - Marcos Pariona
- Departamento de CardiologíaHospital Nacional Edgardo Rebagliati MartinsLimaPeru
| | - Mercedes Rivas‐Lasarte
- Unidad de Insuficiencia Cardiaca Avanzada y Trasplante CardiacoHospital Universitario Puerta de HierroMadridSpain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)MadridSpain
| | - Jesús Álvarez‐García
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV)MadridSpain
- Unidad de Insuficiencia Cardíaca Avanzada. Servicio de Cardiología del Hospital Universitario Ramón y CajalMadridSpain
- Universidad Autónoma de BarcelonaBarcelonaSpain
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32
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An W, Kang JS, Wang Q, Kim TE. Cardiac biomarkers and COVID-19: A systematic review and meta-analysis. J Infect Public Health 2021; 14:1191-1197. [PMID: 34416596 PMCID: PMC8320426 DOI: 10.1016/j.jiph.2021.07.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 07/08/2021] [Accepted: 07/26/2021] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To systematically investigate the relationship between cardiac biomarkers and COVID-19 severity and mortality. METHODS We performed a literature search using PubMed, Web of Science, and Google Scholar. The standardized mean difference (SMD) and 95% confidence interval (CI) were applied to estimate the combined results of 67 studies. A meta-analysis of cardiac biomarkers was used to evaluate disease mortality and severity in COVID-19 patients. RESULTS A meta-analysis of 7812 patients revealed that patients with high levels of cardiac troponin I (SMD = 0.81 U/L, 95% CI = 0.14-1.48, P = 0.017), cardiac troponin T (SMD = 0.78 U/L, 95% CI = 0.07-1.49, P = 0.032), high-sensitive cardiac troponin I (SMD = 0.66 pg/mL, 95% CI = 0.51-0.81, P < 0.001), high-sensitive cardiac troponin T (SMD = 0.93 U/L, 95% CI = 0.21-1.65, P = 0.012), creatine kinase-MB (SMD = 0.54 U/L, 95% CI = 0.39-0.69, P < 0.001), and myoglobin (SMD = 0.80 U/L, 95% CI = 0.57-1.03, P < 0.001) were associated with prominent disease severity in COVID-19 infection. Moreover, 9532 patients with a higher serum level of cardiac troponin I (SMD = 0.51 U/L, 95% CI = 0.37-0.64, P < 0.001), high-sensitive cardiac troponin (SMD = 0.51 ng/L, 95% CI = 0.29-0.73, P < 0.001), high-sensitive cardiac troponin I (SMD = 0.51 pg/mL, 95% CI = 0.38-0.63, P < 0.001), high-sensitive cardiac troponin T (SMD = 0.85 U/L, 95% CI = 0.63-1.07, P < 0.001), creatine kinase-MB (SMD = 0.48 U/L, 95% CI = 0.32-0.65, P < 0.001), and myoglobin (SMD = 0.55 U/L, 95% CI = 0.45-0.65, P < 0.001) exhibited a prominent level of mortality from COVID-19 infection. CONCLUSION Cardiac biomarkers (cardiac troponin I, cardiac troponin T, high-sensitive cardiac troponin, high-sensitive cardiac troponin I, high-sensitive cardiac troponin T, creatine kinase-MB, and myoglobin) should be more frequently applied in identifying high-risk COVID-19 patients so that timely treatment can be implemented to reduce severity and mortality in COVID-19 patients.
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Affiliation(s)
- Wen An
- Department of Pharmacology & Clinical Pharmacology, College of Medicine, Hanyang University, Seoul, Republic of Korea.
| | - Ju-Seop Kang
- Department of Pharmacology & Clinical Pharmacology, College of Medicine, Hanyang University, Seoul, Republic of Korea.
| | - Qiuyang Wang
- Department of Central China Research Institute of Health, Xinxiang Medical University, Xinxiang, China.
| | - Tae-Eun Kim
- Department of Clinical Pharmacology, Konkuk University Hospital, Seoul, Republic of Korea.
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33
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Hallett AM, Greenberg RS, Boyarsky BJ, Shah PD, Ou MT, Teles AT, Krach MR, López JI, Werbel WA, Avery RK, Bae S, Tobian AA, Massie AB, Higgins RSD, Garonzik-Wang JM, Segev DL, Bush EL. SARS-CoV-2 messenger RNA vaccine antibody response and reactogenicity in heart and lung transplant recipients. J Heart Lung Transplant 2021; 40:1579-1588. [PMID: 34456108 PMCID: PMC8349311 DOI: 10.1016/j.healun.2021.07.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 01/22/2023] Open
Abstract
Background While several studies have observed that solid organ transplant recipients experience diminished antibody responses to SARS-CoV-2 mRNA vaccination, data specific to heart and lung transplant (HT/LT) recipients remains sparse. Methods US adult HT and LT recipients completed their vaccine series between January 7 and April 10, 2021. Reactogencity and SARS-CoV-2 anti-spike antibody were assessed after a priming dose (D1) and booster dose (D2). Modified Poisson regression with robust variance estimator was used to evaluate associations between participant characteristics and antibody development. Results Of 134 heart recipients, there were 38% non-responders (D1-/D2-), 48% booster responders (D1-/D2+), and 14% priming dose responders (D1+/D2+). Of 103 lung recipients, 64% were non-responders, 27% were booster responders, and 9% were priming dose responders. Lung recipients were less likely to develop antibodies (p < .001). Priming dose antibody response was associated with younger recipient age (p = .04), transplant-to-vaccination time ≥6 years (p < .01), and lack of anti-metabolite maintenance immunosuppression (p < .001). Pain at injection site was the most commonly reported reaction (85% after D1, 76% after D2). Serious reactions were rare, the most common being fatigue (2% after D1 and 3% after D2). No serious adverse events were reported. Conclusions HT and LT recipients experienced diminished antibody response following vaccination; reactogenicity was comparable to that of the general population. LT recipients may exhibit a more impaired antibody response than HT recipients. While current recommendations are to vaccinate eligible candidates and recipients, further studies characterizing the cell-mediated immune response and clinical efficacy of these vaccines in this population are needed.
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Affiliation(s)
- Andrew M Hallett
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ross S Greenberg
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Brian J Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Pali D Shah
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michael T Ou
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aura T Teles
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Michelle R Krach
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Julia I López
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - William A Werbel
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robin K Avery
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Sunjae Bae
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Aaron A Tobian
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Robert S D Higgins
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland
| | - Errol L Bush
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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34
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Duran JM, Barat M, Lin AY, King KR, Greenberg B, Adler ED, Aslam S. Low mortality in SARS-CoV-2 infected heart transplant recipients at a single center. Clin Transplant 2021; 36:e14443. [PMID: 34320235 PMCID: PMC8420241 DOI: 10.1111/ctr.14443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/12/2021] [Accepted: 07/21/2021] [Indexed: 12/15/2022]
Abstract
Immunosuppressed heart transplant (HT) recipients are thought to be at higher risk of infection and mortality from SARS-CoV-2 infection coronavirus disease 2019 (COVID-19), however evidence guiding management of HT patients are limited. Retrospective search of electronic health records from February 2020 - February 2021, identified 28 HT recipients out of 400 followed by UC San Diego who tested positive for SARS-CoV-2. Patient demographics, COVID-19 directed therapies, hospital course and outcomes were compared to control HT recipients who tested negative for SARS-CoV-2 during the same period (n = 80). Among 28 HT recipients who tested positive for SARS-CoV-2, 15 were admitted to the hospital and 13 were monitored closely as outpatients. Among inpatients, five developed severe illness and two died (7% mortality). Nine patients were treated with remdesivir, and four received dexamethasone and remdesivir. Two outpatients received neutralizing monoclonal antibody therapy and one outpatient received dexamethasone for persistent dyspnea. Immunosuppressed HT recipients, especially Hispanic patients and patients with higher body mass index, were at greater risk of infection and mortality from COVID-19 than the general population. Use of remdesivir and dexamethasone may have improved outcomes in our HT recipients compared to HT recipients at other centers. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jason M Duran
- Division of Cardiology, Department of Internal Medicine, University of California San Diego Sulpizio Cardiovascular Center, La Jolla, California, USA
| | - Masihullah Barat
- Division of Cardiology, Department of Internal Medicine, University of California San Diego Sulpizio Cardiovascular Center, La Jolla, California, USA
| | - Andrew Y Lin
- Division of Cardiology, Department of Internal Medicine, University of California San Diego Sulpizio Cardiovascular Center, La Jolla, California, USA
| | - Kevin R King
- Division of Cardiology, Department of Internal Medicine, University of California San Diego Sulpizio Cardiovascular Center, La Jolla, California, USA
| | - Barry Greenberg
- Division of Cardiology, Department of Internal Medicine, University of California San Diego Sulpizio Cardiovascular Center, La Jolla, California, USA
| | - Eric D Adler
- Division of Cardiology, Department of Internal Medicine, University of California San Diego Sulpizio Cardiovascular Center, La Jolla, California, USA
| | - Saima Aslam
- Division of Infectious Diseases and Global Public Health, Department of Internal Medicine, University of California San Diego Sulpizio Cardiovascular Center, La Jolla, California, USA
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35
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Adherence to Immunosuppression Medications among Heart Transplant Recipients: Challenges, Opportunities, and Potential Role of Digital Approaches in the COVID-19 Era. J Cardiovasc Dev Dis 2021; 8:jcdd8060068. [PMID: 34200823 PMCID: PMC8230436 DOI: 10.3390/jcdd8060068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 12/16/2022] Open
Abstract
Society and medical practice have been restructured dramatically to avoid further spread of the COVID-19 virus; telehealth/telemedicine, mask wearing, and nationwide social distancing practices have become widespread. However, we still face unprecedented challenges in fields where patients require frequent and active follow-up visits for monitoring, including that of solid-organ transplant, and in particular, heart transplant. Adherence to immunosuppression remains a unique challenge in heart transplantation, especially during the COVID-19 pandemic. Failure to adhere to immunosuppression can have disastrous consequences, including graft rejection and death. In this article, we discuss challenges related to adherence to immunosuppression medications among heart transplant recipients, as well as opportunities to leverage digital approaches and interventions to monitor and optimize adherence behavior and health outcomes in this population.
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36
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Amabile A, Geirsson A. Heart transplantations amidst the COVID-19 pandemic: "In the midst of chaos, there is also opportunity". J Card Surg 2021; 36:3222-3223. [PMID: 34101903 PMCID: PMC8242748 DOI: 10.1111/jocs.15732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/02/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Andrea Amabile
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
| | - Arnar Geirsson
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA
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37
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Kniepeiss D, Jantscher L, Al-Sharafy S, Sendlhofer G, Schemmer P. Framework for Solid-Organ Transplantation During COVID-19 Pandemic in Europe. Risk Manag Healthc Policy 2021; 14:2421-2433. [PMID: 34113196 PMCID: PMC8187091 DOI: 10.2147/rmhp.s286721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/29/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Since the effect of the COVID-19 pandemic on solid-organ transplantation (SOT) is unclear, an online survey on the specific framework of leading European transplant centers (n=155) in 31 European countries was conducted between April 24 and May 15, 2020. METHODS A questionnaire was designed to collect information on restrictions on SOT, protective measures,(non)governmental information policies, and individual opinions on how to deal with SOT during COVID-19. RESULTS The response rate was 37.4% (58 of 155). Overall, 84.5% reported an effect of COVID-19 on SOT in Europe. In 49% of these, limited capacity was mentioned, and in 51% the reason for restricted resources was strategic preparedness. As a result, SOT was totally or partially suspended for several weeks. In sum, 93.1% of centers implemented protective measures against COVID-19. Nongovernmental information policies were felt to be adequate in 90%. Continuation of transplant activities was desired by 97% of centers. CONCLUSION The results of this survey suggested a need for more ICU capacity during COVID-19, in order to guarantee adequate and timely treatment of other patient cohorts in surveyed countries.
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Affiliation(s)
- Daniela Kniepeiss
- General, Visceral, and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- University Transplant Center Graz (UTCG), Medical University Graz,, Graz, Austria
| | - Lydia Jantscher
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Shahdy Al-Sharafy
- General, Visceral, and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- University Transplant Center Graz (UTCG), Medical University Graz,, Graz, Austria
| | - Gerald Sendlhofer
- Research Unit for Safety in Health, c/o Division of Plastic, Aesthetic, and Reconstructive Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Executive Department for Quality and Risk Management, University Hospital Graz, Graz, Austria
| | - Peter Schemmer
- General, Visceral, and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- University Transplant Center Graz (UTCG), Medical University Graz,, Graz, Austria
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Yetmar ZA, Beam E, O’Horo JC, Ganesh R, Bierle DM, Brumble L, Seville MT, Razonable RR. Monoclonal Antibody Therapy for COVID-19 in Solid Organ Transplant Recipients. Open Forum Infect Dis 2021; 8:ofab255. [PMID: 34631921 PMCID: PMC8494079 DOI: 10.1093/ofid/ofab255] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Accepted: 05/13/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Bamlanivimab and casirivimab-imdevimab are authorized for emergency use treatment of mild to moderate coronavirus disease 2019 (COVID-19) in patients at high risk for developing severe disease or hospitalization. Their safety and efficacy have not been specifically evaluated in solid organ transplant recipients. METHODS We retrospectively reviewed solid organ transplant recipients who received monoclonal antibody infusion for COVID-19 at Mayo Clinic sites through January 23, 2021. Outcomes included emergency department visit, hospitalization, mortality, and allograft rejection. RESULTS Seventy-three patients were treated, most commonly with bamlanivimab (75.3%). The median age was 59 years, 63% were male, and the median Charlson comorbidity index was 5. Transplant type included 41 kidney (56.2%), 13 liver (17.8%), 11 heart (15.1%), 4 kidney-pancreas (5.5%), 2 lung (2.7%), 1 heart-liver, and 1 pancreas. Eleven (15.1%) patients had an emergency department visit within 28 days of infusion, including 9 (12.3%) who were hospitalized for a median of 4 days. One patient required intensive care unit admission for a nonrespiratory complication. No patients required mechanical ventilation, died, or experienced rejection. Ten adverse events occurred, with 1 seeking medical evaluation. Hypertension was associated with hospital admission (P < .05), while other baseline characteristics were similar. The median time from symptom onset to antibody administration was 4 days in nonhospitalized patients compared with 6 days among hospitalized patients (P < .05). CONCLUSIONS Monoclonal antibody treatment has favorable outcomes with minimal adverse effects in solid organ transplant recipients with mild to moderate COVID-19. Earlier administration of monoclonal antibody therapy appears to be more efficacious.
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Affiliation(s)
- Zachary A Yetmar
- Division of Infectious Diseases, Mayo
Clinic, Rochester, Minnesota, USA
| | - Elena Beam
- Division of Infectious Diseases, Mayo
Clinic, Rochester, Minnesota, USA
| | - John C O’Horo
- Division of Infectious Diseases, Mayo
Clinic, Rochester, Minnesota, USA
- Divison of Pulmonary and Critical Care Medicine, Mayo
Clinic, Rochester, Minnesota, USA
| | - Ravindra Ganesh
- Division of General Internal Medicine, Mayo
Clinic, Rochester, Minnesota, USA
| | - Dennis M Bierle
- Division of General Internal Medicine, Mayo
Clinic, Rochester, Minnesota, USA
| | - Lisa Brumble
- Division of Infectious Diseases, Mayo
Clinic, Jacksonville, Florida, USA
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39
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Goldman JD, Robinson PC, Uldrick TS, Ljungman P. COVID-19 in immunocompromised populations: implications for prognosis and repurposing of immunotherapies. J Immunother Cancer 2021; 9:e002630. [PMID: 34117116 PMCID: PMC8206176 DOI: 10.1136/jitc-2021-002630] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 02/06/2023] Open
Abstract
SARS-CoV-2 is the virus responsible for the COVID-19 pandemic. COVID-19 has highly variable disease severity and a bimodal course characterized by acute respiratory viral infection followed by hyperinflammation in a subset of patients with severe disease. This immune dysregulation is characterized by lymphocytopenia, elevated levels of plasma cytokines and proliferative and exhausted T cells, among other dysfunctional cell types. Immunocompromised persons often fare worse in the context of acute respiratory infections, but preliminary data suggest this may not hold true for COVID-19. In this review, we explore the effect of SARS-CoV-2 infection on mortality in four populations with distinct forms of immunocompromise: (1) persons with hematological malignancies (HM) and hematopoietic stem cell transplant (HCT) recipients; (2) solid organ transplant recipients (SOTRs); (3) persons with rheumatological diseases; and (4) persons living with HIV (PLWH). For each population, key immunological defects are described and how these relate to the immune dysregulation in COVID-19. Next, outcomes including mortality after SARS-CoV-2 infection are described for each population, giving comparisons to the general population of age-matched and comorbidity-matched controls. In these four populations, iatrogenic or disease-related immunosuppression is not clearly associated with poor prognosis in HM, HCT, SOTR, rheumatological diseases, or HIV. However, certain individual immunosuppressants or disease states may be associated with harmful or beneficial effects, including harm from severe CD4 lymphocytopenia in PLWH and possible benefit to the calcineurin inhibitor ciclosporin in SOTRs, or tumor necrosis factor-α inhibitors in persons with rheumatic diseases. Lastly, insights gained from clinical and translational studies are explored as to the relevance for repurposing of immunosuppressive host-directed therapies for the treatment of hyperinflammation in COVID-19 in the general population.
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Affiliation(s)
- Jason D Goldman
- Swedish Center for Research and Innovation, Swedish Medical Center, Seattle, Washington, USA
- Providence St. Joseph Health, Renton, Washington, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Philip C Robinson
- The University of Queensland Faculty of Medicine, Herston, Queensland, Australia
- Metro North Hospital and Health Service, Royal Brisbane and Woman's Hospital Health Service District, Herston, Queensland, Australia
| | - Thomas S Uldrick
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, Washington, USA
| | - Per Ljungman
- Department. of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital Huddinge, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
- Division of Hematology, Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden
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40
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Affiliation(s)
- Felix Schoenrath
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site, Berlin, Germany
| | - Volkmar Falk
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany.,Department of Cardiothoracic Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Germany.,Department of Health Sciences, ETH Zurich, Translational Cardiovascular Technologies, Switzerland
| | - Maximilian Y Emmert
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Germany.,Department of Cardiothoracic Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Berlin, and Berlin Institute of Health, Germany.,Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland
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Genuardi MV, Moss N, Najjar SS, Houston BA, Shore S, Vorovich E, Atluri P, Molina M, Chambers S, Sharkoski T, Hsich E, Estep JD, Owens AT, Alexander KM, Chaudhry SP, Garcia-Cortes R, Molina E, Rodrigo M, Wald MDJ, Margulies KB, Hanff TC, Zimmer R, Kilic A, Mclean R, Vidula H, Dodd K, Blumberg EA, Mazurek JA, Goldberg LR, Alvarez-Garcia J, Mancini D, Teuteberg JJ, Tedford RJ, Birati EY. Coronavirus disease 2019 in heart transplant recipients: Risk factors, immunosuppression, and outcomes. J Heart Lung Transplant 2021; 40:926-935. [PMID: 34140222 PMCID: PMC8131557 DOI: 10.1016/j.healun.2021.05.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 04/28/2021] [Accepted: 05/11/2021] [Indexed: 12/14/2022] Open
Abstract
Background COVID-19 continues to inflict significant morbidity and mortality, particularly on patients with preexisting health conditions. The clinical course, outcomes, and significance of immunosuppression regimen in heart transplant recipients with COVID-19 remains unclear. Methods We included the first 99 heart transplant recipients at participating centers with COVID-19 and followed patients until resolution. We collected baseline information, symptoms, laboratory studies, vital signs, and outcomes for included patients. The association of immunosuppression regimens at baseline with severe disease were compared using logistic regression, adjusting for age and time since transplant. Results The median age was 60 years, 25% were female, and 44% were white. The median time post-transplant to infection was 5.6 years. Overall, 15% died, 64% required hospital admission, and 7% remained asymptomatic. During the course of illness, only 57% of patients had a fever, and gastrointestinal symptoms were common. Tachypnea, oxygen requirement, elevated creatinine and inflammatory markers were predictive of severe course. Age ≥ 60 was associated with higher risk of death and the use of the combination of calcineurin inhibitor, antimetabolite, and prednisone was associated with more severe disease compared to the combination of calcineurin inhibitor and antimetabolite alone (adjusted OR = 7.3, 95% CI 1.8-36.2). Among hospitalized patients, 30% were treated for secondary infection, acute kidney injury was common and 17% required new renal replacement therapy. Conclusions We present the largest study to date of heart transplant patients with COVID-19 showing common atypical presentations and a high case fatality rate of 24% among hospitalized patients and 16% among symptomatic patients.
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Affiliation(s)
- Michael V Genuardi
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Noah Moss
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | | | - Supriya Shore
- Cardiovascular Division, University of Michigan, Ann Arbor, MI
| | - Esther Vorovich
- Division of Cardiology, Northwestern University, Chicago, IL
| | - Pavan Atluri
- Department of Cardiothoracic Surgery, University of Pennsylvania, Pennsylvania
| | - Maria Molina
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan Chambers
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tiffany Sharkoski
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eileen Hsich
- Heart and Vascular Institute at the Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH
| | - Jerry D Estep
- Heart and Vascular Institute at the Cleveland Clinic and Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, OH
| | - Anjali T Owens
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kevin M Alexander
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | | | | | | | | | - MDc Joyce Wald
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth B Margulies
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Thomas C Hanff
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ross Zimmer
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Arman Kilic
- Division of Cardiac Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Rhondalyn Mclean
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Himabindu Vidula
- Division of Cardiology, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Katherine Dodd
- Division of Cardiology, Northwestern University, Chicago, IL
| | - Emily A Blumberg
- Division of Infectious Diseases, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jeremy A Mazurek
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Lee R Goldberg
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jesus Alvarez-Garcia
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Donna Mancini
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jeffrey J Teuteberg
- Division of Cardiovascular Medicine and the Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA
| | | | - Edo Y Birati
- Cardiovascular Division, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular Outcomes, Quality, and Evaluative Research Center, University of Pennsylvania, Philadelphia, Pennsylvania; Cardiovascular division, Poriya Medical Center, Bar Ilan University, Israel
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42
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Gilliland S, Tran T, Alber S, Krause M, Weitzel N. Year in Review 2020: Noteworthy Literature in Cardiothoracic Critical Care. Semin Cardiothorac Vasc Anesth 2021; 25:128-137. [PMID: 33988043 DOI: 10.1177/10892532211016167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This year will be forever marked by the drastic changes COVID-19 wrought on our personal and professional lives. New roles and challenges in critical care have forced us to be constantly nimble and flexible in how we approach medicine. The strain of these challenges is apparent throughout the health care community and our society as a whole. Despite this adversity, 2020 will also be remembered for fantastic advances in research. This article is a collection of influential and exciting studies published in 2020 encompassing a broad swath of critical care with a focus on cardiothoracic critical care. Themes include examinations of early extracorporeal membrane oxygenation support for out-of-hospital cardiac arrest patients, the impact of sedation and other risk factors on perioperative mortality, a novel fluid resuscitation strategy following cardiac surgery, and advances in the fields of heart and lung transplantation as well as how they were affected by COVID-19. Given that many cardiothoracic intensivists were redeployed to the care of SARS-CoV-2 patients, we also discuss important advances in therapeutics for the virus.
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Oktaviono YH, Mulia EPB, Luke K, Nugraha D, Maghfirah I, Subagjo A. Right ventricular dysfunction and pulmonary hypertension in COVID-19: a meta-analysis of prevalence and its association with clinical outcome. Arch Med Sci 2021; 18:1169-1180. [PMID: 36160328 PMCID: PMC9479723 DOI: 10.5114/aoms/136342] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/03/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction Rapid spread of COVID-19 has caused detrimental effects globally. Involvement of the ACE2 receptor has identified COVID-19 as a multi-organ disease. Preliminary studies have provided evidence that cardiac involvement, including right ventricular dysfunction (RVD) and pulmonary hypertension (PH), were found in COVID-19 cases, even in the non-advanced stage. This meta-analysis aims to analyze the prevalence of RVD and PH, and their association with COVID-19 clinical outcome. Material and methods A systematic data search was conducted through PubMed, medRxiv, ProQuest, Science Direct, and Scopus databases using constructed keywords based on MeSH terms. Any outcomes regarding mortality, severity, ICU admission, and mechanical ventilation usage were analyzed using RevMan v.5.4 and Stata v.16. Results A total of 16 eligible studies (1,728 patients) were included. Pooled prevalence of RVD in COVID-19 was 19% (95% CI: 13-25%), and PH was 22% (95% CI: 14-31%). RVD was associated with increased mortality (OR = 2.98 (95% CI: 1.50-5.89), p = 0.002), severity (OR = 3.61 (95% CI: 2.05-6.35), p < 0.001), ICU admission (OR = 1.70 (95% CI: 1.12-2.56), p = 0.01), and mechanical ventilation (MV) usage (OR = 1.60 (95% CI: 1.14-2.25), p = 0.007). PH was also associated with increased mortality (OR = 5.42 (95% CI: 2.66-11.060, p < 0.001), severity (OR = 5.74 (95% CI: 2.28-14.49), p < 0.001), and ICU admission (OR = 12.83 (95% CI: 3.55-46.41), p < 0.001). Conclusions RVD and PH were prevalent in COVID-19 and associated with mortality, severity, ICU admission, and MV usage in COVID-19 patients. Bedside echocardiography examination could be considered as a novel risk stratification tool in COVID-19.
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Affiliation(s)
- Yudi Her Oktaviono
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Eka Prasetya Budi Mulia
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Kevin Luke
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - David Nugraha
- Faculty of Medicine, Universitas Airlangga, Surabaya, Indonesia
| | - Irma Maghfirah
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya, Indonesia
| | - Agus Subagjo
- Department of Cardiology and Vascular Medicine, Faculty of Medicine, Universitas Airlangga – Dr. Soetomo General Hospital, Surabaya, Indonesia
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Driggin E, Maddox TM, Ferdinand KC, Kirkpatrick JN, Ky B, Morris AA, Mullen JB, Parikh SA, Philbin DM, Vaduganathan M. ACC Health Policy Statement on Cardiovascular Disease Considerations for COVID-19 Vaccine Prioritization: A Report of the American College of Cardiology Solution Set Oversight Committee. J Am Coll Cardiol 2021; 77:1938-1948. [PMID: 33587998 PMCID: PMC7880623 DOI: 10.1016/j.jacc.2021.02.017] [Citation(s) in RCA: 38] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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45
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Heart-lung interactions in COVID-19: prognostic impact and usefulness of bedside echocardiography for monitoring of the right ventricle involvement. Heart Fail Rev 2021; 27:1325-1339. [PMID: 33864580 PMCID: PMC8052527 DOI: 10.1007/s10741-021-10108-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2021] [Indexed: 12/22/2022]
Abstract
Due to the SARS-CoV-2 infection–related severe pulmonary tissue damages associated with a relative specific widespread thrombotic microangiopathy, the pathophysiologic role of heart–lung interactions becomes crucial for the development and progression of right ventricular (RV) dysfunction. The high resistance in the pulmonary circulation, as a result of small vessel thrombosis and hypoxemia, is the major cause of right heart failure associated with a particularly high mortality in severe COVID-19. Timely identification of patients at high risk for RV failure, optimization of mechanical ventilation to limit its adverse effects on RV preload and afterload, avoidance of medication-related increase in the pulmonary vascular resistance, and the use of extracorporeal membrane oxygenation in refractory respiratory failure with hemodynamic instability, before RV failure develops, can improve patient survival. Since it was confirmed that the right-sided heart is particularly involved in the clinical deterioration of patients with COVID-19 and pressure overload-induced RV dysfunction plays a key role for patient outcome, transthoracic echocardiography (TTE) received increasing attention. Limited TTE focused on the right heart appears highly useful in hospitalized COVID-19 patients and particularly beneficial for monitoring of critically ill patients. In addition to detection of right-sided heart dilation and RV dysfunction, it enables assessment of RV-pulmonary arterial coupling and evaluation of RV adaptability to pressure loading which facilitate useful prognostic statements to be made. The increased use of bedside TTE focused on the right heart could facilitate more personalized management and treatment of hospitalized patients and can contribute towards reducing the high mortality associated with SARS-CoV-2 infection.
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Nakano H, Shiina K, Tomiyama H. Cardiovascular Outcomes in the Acute Phase of COVID-19. Int J Mol Sci 2021; 22:ijms22084071. [PMID: 33920790 PMCID: PMC8071172 DOI: 10.3390/ijms22084071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 02/06/2023] Open
Abstract
The cumulative number of cases in the current global coronavirus disease 19 (COVID-19) pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has exceeded 100 million, with the number of deaths caused by the infection having exceeded 2.5 million. Recent reports from most frontline researchers have revealed that SARS-CoV-2 can also cause fatal non-respiratory conditions, such as fatal cardiovascular events. One of the important mechanisms underlying the multiple organ damage that is now known to occur during the acute phase of SARS-CoV-2 infection is impairment of vascular function associated with inhibition of angiotensin-converting enzyme 2. To manage the risk of vascular dysfunction-related complications in patients with COVID-19, it would be pivotal to clearly elucidate the precise mechanisms by which SARS-CoV-2 infects endothelial cells to cause vascular dysfunction. In this review, we summarize the current state of knowledge about the mechanisms involved in the development of vascular dysfunction in the acute phase of COVID-19.
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Affiliation(s)
- Hiroki Nakano
- Department of Cardiology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.N.); (K.S.)
| | - Kazuki Shiina
- Department of Cardiology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.N.); (K.S.)
| | - Hirofumi Tomiyama
- Department of Cardiology, Tokyo Medical University, Tokyo 160-0023, Japan; (H.N.); (K.S.)
- Department of Cardiology and Division of Pre-Emptive Medicine for Vascular Damage, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan
- Correspondence:
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Granger C, Guedeney P, Arnaud C, Guendouz S, Cimadevilla C, Kerneis M, Kerneis C, Zeitouni M, Verdonk C, Legeai C, Lebreton G, Leprince P, Désiré E, Sorrentino S, Silvain J, Montalescot G, Hazan F, Varnous S, Dorent R. Clinical manifestations and outcomes of coronavirus disease-19 in heart transplant recipients: a multicentre case series with a systematic review and meta-analysis. Transpl Int 2021; 34:721-731. [PMID: 33539616 PMCID: PMC8014589 DOI: 10.1111/tri.13837] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 10/14/2020] [Accepted: 01/29/2021] [Indexed: 01/08/2023]
Abstract
Available data on clinical presentation and mortality of coronavirus disease-2019 (COVID-19) in heart transplant (HT) recipients remain limited. We report a case series of laboratory-confirmed COVID-19 in 39 HT recipients from 3 French heart transplant centres (mean age 54.4 ± 14.8 years; 66.7% males). 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-centre HT recipient cohort was 56% higher in 2020 compared to the time-matched 2019 cohort (2% vs. 1.28%, P = 0.15). In a meta-analysis including 4 studies, pre-existing 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. These findings highlight the aggressive clinical course of COVID-19 in HT recipients.
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Affiliation(s)
- Camille Granger
- ACTION Study GroupINSERM UMRS_1166Institut de CardiologiePitié SalpêtrièreAssistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Paul Guedeney
- ACTION Study GroupINSERM UMRS_1166Institut de CardiologiePitié SalpêtrièreAssistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Camille Arnaud
- Département de Chirurgie CardiaqueHôpital BichatAssistance Publique‐Hôpitaux de ParisUniversité de ParisParisFrance
| | - Soulef Guendouz
- Département de CardiologieHôpital Henri‐MondorAssistance Publique‐Hôpitaux de ParisCréteilFrance
| | - Claire Cimadevilla
- Département de Chirurgie CardiaqueHôpital BichatAssistance Publique‐Hôpitaux de ParisUniversité de ParisParisFrance
| | - Mathieu Kerneis
- ACTION Study GroupINSERM UMRS_1166Institut de CardiologiePitié SalpêtrièreAssistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Caroline Kerneis
- Département de Chirurgie CardiaqueHôpital BichatAssistance Publique‐Hôpitaux de ParisUniversité de ParisParisFrance
| | - Michel Zeitouni
- ACTION Study GroupINSERM UMRS_1166Institut de CardiologiePitié SalpêtrièreAssistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Constance Verdonk
- Département de Chirurgie CardiaqueHôpital BichatAssistance Publique‐Hôpitaux de ParisUniversité de ParisParisFrance
| | - Camille Legeai
- Agence de la BiomédecineDirection Prélèvement Greffe Organes‐TissusSaint Denis La PlaineFrance
| | - Guillaume Lebreton
- Département de Chirurgie CardiaqueInstitut de CardiologiePitié Salpêtrière Assistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Pascal Leprince
- Département de Chirurgie CardiaqueInstitut de CardiologiePitié Salpêtrière Assistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Eva Désiré
- Département de Chirurgie CardiaqueInstitut de CardiologiePitié Salpêtrière Assistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Sabato Sorrentino
- Division of CardiologyDepartment of Medical and Surgical SciencesURT National Research Council (CNR)Magna Graecia UniversityCatanzaroItaly
| | - Johanne Silvain
- ACTION Study GroupINSERM UMRS_1166Institut de CardiologiePitié SalpêtrièreAssistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Gilles Montalescot
- ACTION Study GroupINSERM UMRS_1166Institut de CardiologiePitié SalpêtrièreAssistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Fanny Hazan
- Département de Chirurgie CardiaqueInstitut de CardiologiePitié Salpêtrière Assistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Shaida Varnous
- Département de Chirurgie CardiaqueInstitut de CardiologiePitié Salpêtrière Assistance Publique‐Hôpitaux de ParisSorbonne UniversitéParisFrance
| | - Richard Dorent
- Département de Chirurgie CardiaqueHôpital BichatAssistance Publique‐Hôpitaux de ParisUniversité de ParisParisFrance
- Agence de la BiomédecineDirection Prélèvement Greffe Organes‐TissusSaint Denis La PlaineFrance
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Presentation of SARS-CoV-2 in a Pediatric Heart Transplant Recipient with Multiple Underlying Comorbidities. TRANSPLANTOLOGY 2021. [DOI: 10.3390/transplantology2010009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A six-year-old heart transplant recipient with additional significant co-morbidities, including severe hypoxic-ischemic injury, gastrostomy, tracheostomy, and mechanical ventilation dependency, encountered SARS-CoV-2 infection. The patient received tacrolimus and mycophenolate to prevent graft rejection, presented initially with SARS-CoV-2 positive and presumed pseudomonas aeruginosa pneumonia. Twenty-three days later, the patient presented with fever recurrence with evidence for systemic inflammation, which resolved rapidly with high-dose methylprednisolone. Interestingly, while IgM to SARS-CoV-2 was present, IgG was not detected even three months after his first positive test for SARS-CoV-2. The author discusses potential immune mechanisms that might have affected the course of multi-system inflammatory syndrome children (MIS-C) in this patient.
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Manolis AS, Manolis TA, Manolis AA, Melita H. Cardiovascular implications and complications of the coronavirus disease-2019 pandemic: a world upside down. Curr Opin Cardiol 2021; 36:241-251. [PMID: 33395080 DOI: 10.1097/hco.0000000000000838] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE OF REVIEW The new pandemic of coronavirus disease-2019 (COVID-19) has produced a global tumult and has overburdened national health systems. We herein discuss the cardiovascular implications and complications of this pandemic analyzing the most recent data clustered over the last several months. RECENT FINDINGS COVID-19 afflicts the cardiovascular system producing acute cardiac injury in 10-20% of cases with mild disease but in greater than 50-60% in severe cases, contributing to patients' demise. Other cardiovascular complications include arrhythmias, heart failure, pulmonary embolism and shock. Off-label therapies are being trialed with their own inherent cardiovascular risks, while supportive therapies currently dominate, until more specific and effective antiviral therapies and vaccinations become available. A controversial issue relates to the safety of drugs blocking the renin--angiotensin system as an angiotensin-converting enzyme (ACE) homologue, ACE2, serves as the receptor for viral entry into host cells. However, to-date, no harm has been proven for these drugs. SUMMARY In the cardiovascular system, COVID-19 can induce acute cardiac injury, arrhythmias, heart failure, pulmonary embolism, shock and death, whereas anti-COVID therapies also confer serious cardiovascular side-effects. Ongoing extensive efforts focus on specific vaccines and antivirals. Meanwhile, cardiovascular risk factors and diseases should be jointly controlled according to current evidence-based guidelines.
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Affiliation(s)
- Antonis S Manolis
- First Department of Cardiology, Athens University School of Medicine
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50
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Ballout JA, Ahmed T, Kolodziej AR. COVID-19 and Heart Transplant: A Case Series and Review of the Literature. Transplant Proc 2021; 53:1219-1223. [PMID: 33795149 PMCID: PMC7904448 DOI: 10.1016/j.transproceed.2021.02.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 12/23/2022]
Abstract
Coronavirus disease 2019 (COVID-19) has resulted in many challenges in patient care, especially among high-risk populations such as heart transplant recipients. Patients with heart transplant experience a significantly higher mortality rate with COVID-19 infection, and management is based on extrapolation from clinical trials done on nontransplant patients and from clinical experience. Here we report 4 cases of patients with heart transplant who presented with COVID-19 infection in late 2020. Patients presented with symptoms similar to those seen in the general population. All 4 patients were admitted to the hospital, and they were all treated with dexamethasone. In addition, 2 patients received remdesivir. Immunosuppressive medications were adjusted to maintain adequate levels of immunosuppression but at the same time allow for an adequate immune response against the infection. All patients were discharged alive from the hospital. We then performed a literature review on studies that included heart transplant patients who developed the infection and developed suggestions for a standardized management approach, which we share in this article.
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Affiliation(s)
- Jad A Ballout
- Gill Heart Institute, University of Kentucky, Lexington, Kentucky
| | - Taha Ahmed
- Department of Internal Medicine, University of Kentucky, Lexington, Kentucky
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