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Ulrich S, Balmer C, Becker K, Bruhs J, Danne F, Debus V, Dewein L, Di-Bernardo S, Doll U, Fleck T, Tirilomis T, Glöckler M, Grafmann M, Greil S, Grosser U, Saur P, Skrzypek S, Steinmetz M. COVID-19 infection in patients with history of pediatric heart transplant in Germany, Austria, and Switzerland. Clin Transplant 2024; 38:e15272. [PMID: 38445550 DOI: 10.1111/ctr.15272] [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: 03/23/2023] [Revised: 01/27/2024] [Accepted: 02/11/2024] [Indexed: 03/07/2024]
Abstract
COVID-19 is a heterogenous infection-asymptomatic to fatal. While the course of pediatric COVID-19 infections is usually mild or even asymptomatic, individuals after adult heart transplantation are at high risk of a severe infection. We conducted a retrospective, multicenter survey of 16 pediatric heart transplant centers in Germany, Austria and Switzerland to evaluate the risk of a severe COVID-19 infection after pediatric heart transplantation between 02/2020 and 06/2021. Twenty-six subjects (11 male) with a median age of 9.77 years at time of transplantation and a median of 4.65 years after transplantation suffered from COVID-19 infection. The median age at time of COVID-10 infection was 17.20 years. Fourteen subjects had an asymptomatic COVID-19 infection. The most frequent symptoms were myalgia/fatigue (n = 6), cough (n = 5), rhinitis (n = 5), and loss of taste (n = 5). Only one subject showed dyspnea. Eleven individuals needed therapy in an outpatient setting, four subjects were hospitalized. One person needed oxygen supply, none of the subjects needed non-invasive or invasive mechanical ventilation. No specific signs for graft dysfunction were found by non-invasive testing. In pediatric heart transplant subjects, COVID-19 infection was mostly asymptomatic or mild. There were no SARS-CoV-2 associated myocardial dysfunction in heart transplant individuals.
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Affiliation(s)
- Sarah Ulrich
- Department for Pediatric Cardiology and Intensive Care Medicine, Ludwig-Maximilians-University Munich, Munchen, Germany
| | - Christian Balmer
- Department of Pediatric Cardiology, University Children's Hospital Zürich, Zurich, Switzerland
| | - Kolja Becker
- Department of Congenital Heart Disease and Pediatric Cardiology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Josefin Bruhs
- Center of Congenital Heart Disease/Pediatric Cardiology, HDZ-NRW, Ruhr-University, Bad Oeynhausen, Germany
| | - Friederike Danne
- Department of Pediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany
| | - Volker Debus
- Department of Pediatric Cardiology, University Hospital Münster, Münster, Germany
| | - Leonie Dewein
- Department of Pediatrics, University Hospital Ulm, Ulm, Germany
| | - Stefano Di-Bernardo
- Department of Pediatric Cardiology, University Hospital Lausanne, Lausanne, Switzerland
| | - Ulrike Doll
- Department of Pediatric Cardiology, University Hospital Erlangen, Erlangen, Germany
| | - Thilo Fleck
- Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg - Bad Krozingen, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Theodor Tirilomis
- Department of Pediatric Cardiac Surgery, Georg-August-University-Goettingen, Gottingen, Germany
| | - Martin Glöckler
- Center for Congenital Heart Disease, University Hospital for Cardiology, Bern, Switzerland
| | - Maria Grafmann
- Department of Pediatric Cardiology, UKE Hamburg, Hamburg, Germany
| | - Sabine Greil
- Department of Pediatric Cardiology, University Hospital Wien, Wien, Austria
| | - Urte Grosser
- Department of Pediatric Cardiology, University Hospital Hannover, Hannover, Germany
| | - Patrick Saur
- Department of Pediatric Cardiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Susanne Skrzypek
- Department of Pediatric Cardiology, University Hospital Giessen, Giessen, Germany
| | - Michael Steinmetz
- Department of Pediatric Cardiology and Intensive Care Medicine University Medical Center, Georg-August-University-Goettingen, Germany and German Center for Cardiovasvular Research (DZHK), Gottingen, Germany
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2
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Bahakel H, Waghmare A, Madan RP. Impact of Respiratory Viral Infections in Transplant Recipients. J Pediatric Infect Dis Soc 2024; 13:S39-S48. [PMID: 38417082 DOI: 10.1093/jpids/piad094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 10/23/2023] [Indexed: 03/01/2024]
Abstract
Respiratory viral infections (RVIs) are among the leading cause of morbidity and mortality in pediatric hematopoietic stem cell transplant (HCT) and solid organ transplant (SOT) recipients. Transplant recipients remain at high risk for super imposed bacterial and fungal pneumonia, chronic graft dysfunction, and graft failure as a result of RVIs. Recent multicenter retrospective studies and prospective studies utilizing contemporary molecular diagnostic techniques have better delineated the epidemiology and outcomes of RVIs in pediatric transplant recipients and have advanced the development of preventative vaccines and treatment interventions in this population. In this review, we will define the epidemiology and outcomes of RVIs in SOT and HSCT recipients, describe the available assays for diagnosing a suspected RVI, highlight evolving management and vaccination strategies, review the risk of donor derived RVI in SOT recipients, and discuss considerations for delaying transplantation in the presence of an RVI.
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Affiliation(s)
- Hannah Bahakel
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Alpana Waghmare
- Department of Pediatrics, University of Washington, Fred Hutchinson Cancer Research Center; Department of Infectious Diseases, Seattle Children's Hospital, Seattle, WA, USA
| | - Rebecca Pellet Madan
- New York University Grossman School of Medicine; Department of Infectious Diseases, Hassenfeld Children's Hospital, New York, NY, USA
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Torpoco Rivera DM, Joong A, D'Souza N, Duganiero T, Lorts A, Spinner JA. Clinical Outcomes of SARS-CoV-2 Infection in Pediatric Patients on Ventricular Assist Device Support: An ACTION Registry Analysis. ASAIO J 2024; 70:154-158. [PMID: 37862686 DOI: 10.1097/mat.0000000000002080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
Adult patients on left ventricular assist device (LVAD) support have increased morbidity and mortality after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. There are no reported clinical data describing outcomes among pediatric patients on ventricular assist device (VAD) support infected with SARS-CoV-2. We conducted a retrospective study using the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) registry to evaluate patient characteristics and clinical outcomes after SARS-CoV-2 infection. A total of 22 children on VAD support (median age at infection 10.6 years) from 16 centers tested positive for SARS-CoV-2. Cardiomyopathy (59.1%) and congenital heart disease (40.9%) were the most common primary diagnoses. The type of support included LVAD in 19 (86.4%), biventricular assist device (BIVAD) in one (4.5%), and single ventricle VAD in two (9%) patients. At the time of infection, 50% were outpatients, 23% were inpatients on a general cardiology floor, and 27% were in the cardiac intensive care unit (CICU). Most patients (82%) were symptomatic at time of diagnosis, but only 13% required escalation of respiratory support, and 31% received SARS-CoV-2 therapies. Notably, no mortality occurred, and significant morbidity was rare after SARS-CoV-2 infection in pediatric patients on VAD support.
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Affiliation(s)
- Diana M Torpoco Rivera
- From the Department of Pediatrics, Lucile Packard Children's Hospital, Palo Alto, California
| | - Anna Joong
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Nikita D'Souza
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Toni Duganiero
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Angela Lorts
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Joseph A Spinner
- Department of Pediatrics, Texas Children's Hospital, Houston, Texas
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4
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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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Pegado HM, Siqueira A, Navarajasegaran J, Benvenuti LA, Castro CRP, Arrieta SR, Gutierrez PS, Dolhnikoff M, Aiello VD, Jatene MB, Azeka E. Case Report: The Challenge for Diagnosis of Myocarditis and Transplant Rejection After COVID Infection in a Heart-Transplanted Adolescent. Transplant Proc 2023; 55:1449-1450. [PMID: 37516626 DOI: 10.1016/j.transproceed.2023.06.003] [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: 03/30/2023] [Revised: 06/05/2023] [Accepted: 06/22/2023] [Indexed: 07/31/2023]
Abstract
Patients who have undergone organ transplantation are immunosuppressed hosts, leaving them at a higher risk of infections. SARS-COV-2 has been shown to affect heart-transplanted patients. In this case report, we present the case of a 14-year-old heart transplant recipient who developed signs and symptoms of heart failure, along with fatigue, after a COVID-19 infection. An endomyocardial biopsy was performed to diagnose rejection and to evaluate whether this was myocarditis due to SARS-COV-2. The biopsy showed intense acute cellular rejection (3R) and antibody rejection PAMR1 H+ but was negative for the SARS-CoV-2 virus. The patient received organ rejection therapy with high-dose methylprednisolone and human immunoglobulin. After treatment, her heart function recovered, with biopsy investigations showing a lower level of cellular rejection (1R).
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Affiliation(s)
- Helio Milani Pegado
- Heart Institute (InCor), University of São Paulo Medical School (FMUSP), São Paulo, Brasil
| | - Adailson Siqueira
- Heart Institute (InCor), University of São Paulo Medical School (FMUSP), São Paulo, Brasil
| | | | - Luiz Alberto Benvenuti
- Heart Institute (InCor), University of São Paulo Medical School (FMUSP), São Paulo, Brasil
| | | | - Santiago Raul Arrieta
- Heart Institute (InCor), University of São Paulo Medical School (FMUSP), São Paulo, Brasil
| | | | - Marisa Dolhnikoff
- Pathology Department, University of São Paulo Medical School (FMUSP), São Paulo, Brasil
| | - Vera Demarchi Aiello
- Heart Institute (InCor), University of São Paulo Medical School (FMUSP), São Paulo, Brasil
| | | | - Estela Azeka
- Heart Institute (InCor), University of São Paulo Medical School (FMUSP), São Paulo, Brasil.
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Abstract
COVID-19 pandemic continues to evolve and new variants like Delta and Omicron have been discovered. REGEN-COV is a recombinant human monoclonal antibody to the spike protein of SARS-CoV-2 which received emergency use authorisation for treatment and post-exposure prophylaxis in patients with high risk of progression to severe disease. We review our experience with use of REGEN-COV in paediatric heart transplant patients.
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Abstract
The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has significantly impacted all aspects of healthcare including solid organ transplantation. In this review, we discuss the specific impact of COVID-19 on the pediatric solid organ transplant population including access to grafts for pediatric transplant candidates as well as COVID-19 disease manifestations in pediatric transplant recipients. We address the current knowledge of prevention and management of COVID-19 in pediatric transplant recipients and provide additional information regarding social distancing, infection prevention and return to school.
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Affiliation(s)
- Amy G Feldman
- Pediatric Liver Transplant Center, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Digestive Health Institute, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, CO, United States
| | - Lara A Danziger-Isakov
- Immunocompromised Host Infectious Disease, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7017, Cincinnati, OH 45229, United States.
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Case Anecdotes, Opinion and Comment Sotrovimab in pediatric cardiac transplant recipients with SARS-CoV2 infection. J Heart Lung Transplant 2022; 41:1124-1126. [PMID: 35697603 PMCID: PMC9119718 DOI: 10.1016/j.healun.2022.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/22/2022] [Accepted: 05/09/2022] [Indexed: 12/02/2022] Open
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