scholarly journals Coronavirus disease 2019 outcomes in heart transplant recipients: a single-center case series

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Farah Naghashzadeh ◽  
Shadi Shafaghi ◽  
Babak Sharif-Kashani ◽  
Payam Tabarsi ◽  
Leila Saliminejad ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Organ Transplant ◽  
Case Series ◽  
Outpatient Setting ◽  
Clinical Severity ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Transplant Patients ◽  
Treatment Data ◽  
Heart Transplant Recipients

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.

scholarly journals Clinical course and challenging management of early COVID-19 infection after heart transplantation: case report of two patients

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Vincent Tchana-Sato ◽  
Arnaud Ancion ◽  
Julien Tridetti ◽  
Natzi Sakalihasan ◽  
Marie Pierre Hayette ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Clinical Course ◽  
Case Reports ◽  
Organ Transplant ◽  
Case Series ◽  
Perioperative Period ◽  
Severe Form ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Heart Transplant Recipients

Abstract Background There are limited data on Coronavirus disease 2019 (COVID-19) in solid organ transplant patients, especially in heart transplant recipients, with only a few case reports and case series described so far. Heart transplant recipients may be at particular high risk due to their comorbidities and immunosuppressed state. Case presentation This report describes the clinical course and the challenging management of early COVID-19 infection in two heart transplant recipients who tested positive for the SARS-CoV-2 virus in the perioperative period of the transplant procedure. The two patients developed a severe form of the disease and ultimately died despite the initiation of an antiviral monotherapy with hydroxychloroquine coupled with the interruption of mycophenolate mofetil. Conclusions These two cases illustrate the severity and poor prognosis of COVID-19 in the perioperative period of a heart transplant. Thorough screening of donors and recipients is mandatory, and the issue of asymptomatic carriers needs to be addressed.

scholarly journals Clinical course and challenging management of early COVID-19 infection after heart transplantation: Case report of two patients

2020 ◽  
Author(s):  
Vincent Tchana-Sato ◽  
Arnaud Ancion ◽  
Julien Tridetti ◽  
Natzi Sakalihasan ◽  
Marie pierre Hayette ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Clinical Course ◽  
Asymptomatic Carrier ◽  
Case Reports ◽  
Organ Transplant ◽  
Case Series ◽  
Perioperative Period ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Heart Transplant Recipients

Abstract Background: There are limited data on Coronavirus disease 2019 (COVID-19) in solid organ transplant patients and especially in heart transplant recipients with only few case reports and case series described so far. Heart transplant recipients may be at particular high risk due to their comorbidities and immunosuppressed state. Case presentation: This report describes the clinical course and the challenging management of early COVID-19 infection in two heart transplants recipients who were tested positive for the SARS-CoV-2 virus in the perioperative period of the transplant procedure. The two patients developed a severe form of the disease, and ultimately died despite the initiation of an antiviral monotherapy with hydroxychloroquine coupled with the interruption of mycophenolate mofetil. Conclusions: These two cases illustrate the severity and the poor prognosis of COVID-19 in the perioperative period of a heart transplant. Thorough screening of donors and recipients is mandatory and the issue of asymptomatic carrier need to be addressed.

scholarly journals Outcomes of COVID-19 infection in heart transplant recipients

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
D Miklin ◽  
A Mantha ◽  
A Wolfson ◽  
A Vaidya ◽  
E Depasquale
Keyword(s):  
Heart Transplant ◽  
Academic Medical Center ◽  
Case Series ◽  
Transplant Recipients ◽  
Transplant Patients ◽  
Increased Risk ◽  
Gi Symptoms ◽  
History Of ◽  
The Mean ◽  
Heart Transplant Recipients

Abstract Background Heart transplant recipients may be at increased risk for infection and adverse outcomes from infection with COVID-19. Management of these patients is complex, with limited data and no standard of care. Purpose We sought to describe the incidence and outcomes of COVID-19 infection in patients with a history of heart transplant. Methods Retrospective review of 235 heart transplant patients at a large academic medical center identified 31 patients with laboratory confirmed COVID-19 infection. Laboratory and clinical data were collected from our institution as well as other local hospitals patients had been treated at. Outcomes were followed from March 15, 2020 to March 15, 2021. All data was deidentified. Results In a cohort of 235 heart transplant patients, 31 patients were identified after testing positive for COVID-19 infection. The mean and median age of patients was 51.9 and 56.0 years respectively. 71% of patients were male and 29% of patients were female. The mean and median time from transplant to diagnosis was 6.54 and 6.50 years. Average ejection fraction prior to infection was 60.4%. Seventeen patients (55%) had atherosclerosis, ten patients (32%) had diabetes, fifteen patients (48%) had hypertension, and twelve patients (39%) had a history of smoking. 84% of patients were on three types of immunosuppression and 16% were on two. Eight patients (26%) were asymptomatic, six patients (19%) had acute hypoxic respiratory failure, and two patients (7%) had GI symptoms. Two patients had evidence of graft injury with mean AlloSure (donor derived cell free DNA) levels of 0.61%. Immunosuppressive regimens were decreased in 32% of patients and COVID-19 directed therapies were given in 32% of patients. The most common treatments were remdesevir (5 patients), steroids (3 patients), and bamlanivimab (2 patients). Thirteen patients (42%) were hospitalized and two patients (7%) died. Conclusions In a single center case series 31 patients were identified with COVID-19 infection. Nearly half of the patients required hospitalization, with one third of patients decreasing their immunosuppressive regimen and 7% mortality. Further investigation is needed to determine long term outcomes and optimal therapeutic regimen for COVID-19 in this unique population. FUNDunding Acknowledgement Type of funding sources: None.

scholarly journals Adherence to Immunosuppression Medications among Heart Transplant Recipients: Challenges, Opportunities, and Potential Role of Digital Approaches in the COVID-19 Era

2021 ◽  
Vol 8 (6) ◽  
pp. 68
Author(s):  
Tasmeen Hussain ◽  
Keira Nassetta ◽  
Sherif M. Badawy
Keyword(s):  
Heart Transplant ◽  
Potential Role ◽  
Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Adherence Behavior ◽  
Unique Challenge ◽  
Heart Transplant Recipients

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.

Neurocognitive Effects of Solid Organ Transplantation

2010 ◽  
Author(s):  
Nataliya Zelikovsky ◽  
Debra S. Lefkowitz
Keyword(s):  
Organ Transplantation ◽  
Survival Rates ◽  
Organ Transplant ◽  
Solid Organ Transplant ◽  
Chronic Illnesses ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Transplant Patients ◽  
Neurocognitive Outcomes ◽  
Medical Advances

The first successful organ transplant was a kidney transplant performed between identical twins in 1954. Since that time, major medical advances have been made to help improve survival rates for transplant recipients. In 2008, there were 1,964 solid organ transplants performed for children under age 18 (2007 Organ Procurement and Transplantation Network and the Scientific Registry of Transplant Recipients [OPTN/SRTR] Annual Report 1997–2006). Currently, approximately 1,830 pediatric patients are awaiting some type of solid organ transplant (2007 OPTN/SRTR Annual Report 1997–2006). Organ transplantation in children is relatively recent compared to other treatments for children with chronic illnesses. The focus over the first few decades has been on medical advances and improving survival rates for transplant patients. In the recent years, increasing attention has been given to the developmental, neurocognitive, and psychosocial outcomes prior to transplant and in the short-term period post transplant. Most chronic illnesses and acute traumatic medical events have implications for neurocognitive outcomes. End-stage disease of the liver, kidney, heart, and lung are all believed to affect intellectual, academic, and neurocognitive functions. Gross neurodevelopmental deficits have become less common due to early medical intervention (e.g., improved nutrition, surgical intervention, reduced exposure to aluminum (Warady 2002). Organ transplantation is believed to ameliorate the deleterious long-term developmental and neurocognitive effects, but this topic has received little attention in the literature, and the available results with regard to intellectual, academic, and neurodevelopmental results have been mixed. In a combined sample of solid organ transplant patients, 40% had clinically significant cognitive delays (Brosig et al. 2006). Examining the impact of different underlying disease processes and transplantation of each solid organ separately is critical. Thus, we discuss the neurocognitive outcomes of each organ group separately in this chapter. Neurocognitive outcomes can be assessed in a variety of ways depending upon the age of the child. Among infants and toddlers, neurocognitive functioning is measured by an assessment of motor function, social and environmental interaction, and language development. Assessment of older children may involve the evaluation of intelligence, academic achievement, emotional and behavioral functioning, and adaptive skills.

Prior Amiodarone Exposure Reduces Tacrolimus Dosing Requirements in Heart Transplant Recipients

2019 ◽  
Vol 29 (2) ◽  
pp. 129-134 ◽  
Author(s):  
Nadine T. Breslin ◽  
David M. Salerno ◽  
Veli K. Topkara ◽  
Farhana Latif ◽  
Susan Restaino ◽  
...  
Keyword(s):  
Heart Transplant ◽  
Organ Transplant ◽  
Patient Characteristics ◽  
Tacrolimus Concentration ◽  
Transplant Recipients ◽  
Primary Graft Dysfunction ◽  
Graft Dysfunction ◽  
Transplant Patients ◽  
Significant Difference ◽  
And Control

Introduction: Amiodarone use prior to heart transplant is independently associated with a higher rate of severe primary graft dysfunction and in-hospital mortality. Amiodarone may also alter the pharmacokinetics of medications metabolized via cytochrome P450. No data exist regarding the interaction between pretransplant amiodarone and tacrolimus concentrations. Design: Single-center retrospective study of transplant patients between January 1, 2014, and June 30, 2016. A therapeutic tacrolimus concentration was defined as a trough level between 8 and 15 ng/mL for 2 consecutive days. The primary outcome was the tacrolimus therapeutic weight-based dosing requirements (mg/kg/day) for patients receiving amiodarone prior to transplant when compared to those without prior receipt of amiodarone. Secondary outcomes include the incidence of cellular rejection and mortality within 6 months posttransplant. Results: Multi-organ transplant recipients (n = 3), retransplants (n = 9), those who died prior to a therapeutic level (n = 1), and those receiving amiodarone posttransplant (n = 7) were excluded from the analysis. Of the 80 patients included, 34 (42%) received amiodarone prior to transplant. Patient characteristics were similar, with the exception of primary graft dysfunction incidence (38% in amiodarone vs 8.5% in control, P = .001). The median therapeutic dose was 0.1 (interquartile range [IQR]: 0.07-0.12) versus 0.13 (IQR: 0.09-0.17) in the amiodarone and control groups, respectively, ( P < .01). No significant difference in mortality or rejection was noted. Conclusion: Patients receiving amiodarone prior to transplant require a lower weight-based dose of tacrolimus.

scholarly journals COVID‐19 in solid organ transplant recipients: A single‐center case series from Spain

2020 ◽  
Vol 20 (7) ◽  
pp. 1849-1858 ◽  
Author(s):  
Mario Fernández‐Ruiz ◽  
Amado Andrés ◽  
Carmelo Loinaz ◽  
Juan F. Delgado ◽  
Francisco López‐Medrano ◽  
...  
Keyword(s):  
Organ Transplant ◽  
Case Series ◽  
Solid Organ Transplant ◽  
Solid Organ ◽  
Transplant Recipients ◽  
Single Center ◽  
Organ Transplant Recipients ◽  
Solid Organ Transplant Recipients
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