Cardiac transplant recipient with COVID-19 induced acute hypoxic respiratory failure: a case report

Abstract Background Heart transplant recipients represent a particularly vulnerable patient population to the novel coronavirus disease 2019 (COVID-19) due to chronic immunosuppression and high rates of comorbidities. Currently, data are limited and evidence to guide management of heart transplant recipients with COVID-19 is sparse. In this case report, we provide a summary of the current literature as well as an in-depth analysis of our clinical decision-making. Case summary A 67-year-old female who underwent cardiac transplantation 1 year prior was found to have acute hypoxic respiratory failure due to COVID-19. Her immunosuppressant medications were modulated with discontinuation of mycophenolate and titration of tacrolimus troughs with a goal of 6–10 ng/dL. She was administered supportive treatment including convalescent plasma, remdesivir, and dexamethasone, in addition to antibiotic treatment that resulted in resolution of her symptoms within a matter of days despite her precarious disposition. Discussion This case demonstrates that it can be safe and efficacious to modulate immunosuppressant medications in cardiac transplant recipients in accordance with recommendations made by the International Society of Heart and Lung Transplantation. This case additionally demonstrates that aspects of the current literature regarding the management of COVID-19 can be safely extrapolated to cardiac transplant recipients. Providing supportive care with dexamethasone, remdesivir, and convalescent plasma as indicated can be beneficial in cardiac transplant recipients; although, the current literature regarding convalescent plasma and remdesivir is conflicting.

Download Full-text

Parvovirus B19‐induced severe anemia in heart transplant recipients: Case report and review of the literature

Clinical Transplantation ◽

10.1111/ctr.13498 ◽

2019 ◽

Vol 33 (4) ◽

pp. e13498 ◽

Cited By ~ 2

Author(s):

Natalia C. Pinto ◽

Clarissa Newman ◽

Carlos A. Gomez ◽

Kiran K. Khush ◽

Yasbanoo Moayedi ◽

...

Keyword(s):

Case Report ◽

Heart Transplant ◽

Parvovirus B19 ◽

Severe Anemia ◽

Transplant Recipients ◽

Review Of The Literature ◽

Heart Transplant Recipients

Download Full-text

Does cardiac transplant protect against broken hearts?

European Heart Journal ◽

10.1093/ehjci/ehaa946.1178 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Isath ◽

S Perembeti ◽

A Correa ◽

S Rao ◽

A Chahal ◽

...

Keyword(s):

Heart Transplant ◽

Average Length ◽

Myocardial Dysfunction ◽

Case Reports ◽

Fold Increase ◽

Circulatory Support ◽

Cardiac Transplant ◽

Transplant Recipients ◽

The Mean ◽

Heart Transplant Recipients

Abstract Background Takotsubo cardiomyopathy (TC) is a reversible stress-induced myocardial dysfunction with increased sympathetic activity caused by excessive release of catecholamines playing a central role in its pathophysiology. The occurrence of TC in transplanted hearts is rare given the complete denervation done during transplantation. However, it has been demonstrated that 40% of transplant recipients undergo sympathetic re-innervation. There have only been case reports describing TC in post-transplant recipients. Purpose To evaluate the incidence, baseline characteristics and outcomes of TC occurring in heart transplant recipients using Healthcare Cost and Utilization Project (HCUP) National (nationwide) Inpatient Sample (NIS) in United States from 2009 to 2014. Methods Using NIS data, we identified patients who underwent cardiac transplantation using ICD9 procedure codes 37.5 and 33.6. Among these patients, we identified those admitted to the hospital with diagnosis of TC based on ICD-9-CM code 429.83. We presented categorical data as percentages and continuous data as mean or median as appropriate. Results We identified 257 hospitalizations for TC in heart transplant recipient patients. There was an approximately 9-fold increase in admissions from 11 in 2009 to 95 in 2014. Among patients with TC, the mean age was 65.3±1.8 years and majority were female (76.6%). A majority of patients were Caucasians (63%) followed by smaller proportion of African-Americans (13.2%). In-patient mortality in patients admitted with TC following heart transplant was 11.3% (n=29). During the hospitalization, 4.8% of patients had cardiogenic shock and 2.8% required mechanical circulatory support. The average length of stay for patients with TC was 16.6±3.3 days. The mean cost of hospitalization for these patients when adjusted for inflation were 237248±55709 dollars. Conclusion TC can still occur in substantially in heart transplant recipients and should be considered one of the differential diagnosis in transplant patients presenting to the hospital. Funding Acknowledgement Type of funding source: None

Download Full-text

Ventricular Expression and Circulating Levels of Insulin-Like Growth Factor 1 in Heart Transplant Recipients

Clinical Science ◽

10.1042/cs0890053 ◽

1995 ◽

Vol 89 (1) ◽

pp. 53-57

Author(s):

ART Ationu ◽

Michael Burch ◽

Donald Singer ◽

Marc De Leval ◽

Bruce Whitehead ◽

...

Keyword(s):

Growth Factor ◽

Heart Transplant ◽

Soluble Protein ◽

Cardiac Transplant ◽

Insulin Like Growth Factor ◽

Transplant Recipients ◽

Factor I ◽

Heart Transplant Recipients ◽

Growth Factor I ◽

Circulating Levels

1. Insulin-like growth factor I is a major mediator of growth-promoting activities. We studied the ventricular insulin-like growth factor I gene expression at mRNA and peptide levels in 24 heart transplant recipients (14 children and 10 adults), using ‘slot blot' hybridization with insulin-like growth factor I cDNA probe and a specific radioimmunoassay. 2. Ventricular insulin-like growth factor I mRNA was detected in all the cardiac transplant children but was below the limit of detection in the cardiac transplant adults. Ventricular insulin-like growth factor I levels were significantly higher in the transplant children [174 ± 15 (SEM; range 39–950) pg/mg soluble protein] than in transplant adults [39 ± 2 (range 14–85) pg/mg soluble protein, P < 0.01, n = 14]. Circulating levels of insulin-like growth factor I in the cardiac transplant children [164 ± 10 (range 105–192) ng/ml] and adults [176 ± 15 (range 126–244) ng/ml] were within normal ranges for children and adults. 3. These results suggest that the human heart is a site for insulin-like growth factor I production and provide support for an autocrine role for insulin-like growth factor I in the ventricle, despite cardiac denervation.

Download Full-text