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Zwetsloot PP, Smit WL, Van der Kaaij NP, Szymanski MK, Van der Meer MG, Van Laake LW, Troelstra A, Wegdam-Blans MCA, Oerlemans MIFJ. Pre-Operative SARS-CoV-2 Testing in Asymptomatic Heart Transplantation Recipients. Biomedicines 2023; 11:2103. [PMID: 37626599 PMCID: PMC10452735 DOI: 10.3390/biomedicines11082103] [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: 06/15/2023] [Revised: 07/16/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
INTRODUCTION From the start of the coronavirus disease 2019 (COVID-19) pandemic, international guidelines have recommended pre-operative screening for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) before heart transplantation (HTx). Due to the changing prevalence of COVID-19, the chances of false positive results have increased. Because of increased immunity in the population and evolution of SARS-CoV-2 to current Omicron variants, associated mortality and morbidity have decreased. We set out to investigate the yield and side effects of SARS-CoV-2 screening in our center. METHODS We performed a retrospective cohort study in the University Medical Center Utrecht. The study period was from March 2019 to January 2023. All data from patients who underwent HTx were collected, including all pre-operative and post-operative SARS-CoV-2 tests. Furthermore, all clinical SARS-CoV-2 tests for the indication of potential HTx were screened. RESULTS In the period under study, 51 patients underwent HTx. None of the recipients reported any symptoms of a viral infection. Fifty HTx recipients were screened for SARS-CoV-2. Forty-nine out of fifty patients tested negative. One patient had a false positive result, potentially delaying the HTx procedure. There were no cancelled HTx procedures due to a true positive SARS-CoV-2 test result. CONCLUSION Pre-operative SARS-CoV-2 screening in asymptomatic HTx recipients did not lead to any true positive cases. In 2% of the cases, screening resulted in a false positive test result. With the current Omicron variants, in combination with a low-prevalence situation, we propose to abandon pre-operative SARS-CoV-2 screening and initiate a symptom-driven approach for the general viral testing of patients who are called in for a potential HTx.
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Affiliation(s)
- Peter-Paul Zwetsloot
- Department of Cardiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands; (P.-P.Z.); (M.K.S.); (M.G.V.d.M.)
| | - Wouter L. Smit
- Department of Medical Microbiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands; (W.L.S.); (A.T.); (M.C.A.W.-B.)
| | - Niels P. Van der Kaaij
- Department of Cardiothoracic Surgery, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Mariusz K. Szymanski
- Department of Cardiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands; (P.-P.Z.); (M.K.S.); (M.G.V.d.M.)
| | - Manon G. Van der Meer
- Department of Cardiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands; (P.-P.Z.); (M.K.S.); (M.G.V.d.M.)
| | - Linda W. Van Laake
- Department of Cardiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands; (P.-P.Z.); (M.K.S.); (M.G.V.d.M.)
| | - Annet Troelstra
- Department of Medical Microbiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands; (W.L.S.); (A.T.); (M.C.A.W.-B.)
| | - Marjolijn C. A. Wegdam-Blans
- Department of Medical Microbiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands; (W.L.S.); (A.T.); (M.C.A.W.-B.)
| | - Marish I. F. J. Oerlemans
- Department of Cardiology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands; (P.-P.Z.); (M.K.S.); (M.G.V.d.M.)
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Early report from the Pediatric Heart Transplant Society on COVID-19 infections in pediatric heart transplant candidates and recipients. J Heart Lung Transplant 2021; 41:327-333. [PMID: 34903451 PMCID: PMC8604161 DOI: 10.1016/j.healun.2021.11.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 11/02/2021] [Accepted: 11/09/2021] [Indexed: 12/21/2022] Open
Abstract
Background Reports focused on adult heart transplant (HTx) recipients with COVID-19 suggest an increased risk of severe disease, however; it is unclear if this holds true for pediatric HTx patients, given the typically milder course of illness in children in general with COVID-19. We sought to rapidly implement a system for multi-center data collection on pediatric HTx candidates and recipients, with the aim of describing the patient population and infection related outcomes. Methods The Pediatric Heart Transplant Society (PHTS) is a multi-center collaboration that seeks to improve the outcomes of children who are listed and undergo HTx. The society consists of pediatric HTx centers in North America (n = 53), UK (n = 2), and Brazil (n = 1). In response to the pandemic, PHTS developed a web-based platform to collect COVID-19 specific data on pediatric HTx candidates and recipients. Non-PHTS centers were also invited to submit data. Data fields included pre-and post-HTx patient characteristics, presumed versus documented infection, need for hospitalization (including ICU and ventilator use), treatments administered, and 30-day outcome (resolution, death, sequelae, and or unresolved) Results Data collection was initiated on 4/30/20. As of 03/15/21 there were 225 patients [19 pre-HTx and 206 post-HTx, median age 14 years (IQR 7, 18)] reported from 41 centers. Hospitalization occurred in 42% (n = 8) of the pre-HTx and 21% (n=43) of the post-HTx patients. Among the patients listed for HTx, 21% (n = 4) required ICU and 10.5% (n = 2) were mechanically ventilated. Among post-HTx patients, 7% (n = 14) required ICU and 1% (n = 3) were mechanically ventilated. At 30 days, the majority of patients had resolution of symptoms (94.7% pre-HTx, 95.6% post-HTx). One death was reported in a post-HTx patient prior to 30 days from onset of COVID-19 illness. Conclusions These data demonstrate the ability to rapidly adapt the PHTS data collection infrastructure in response to a novel infection and represent the first known multi-center report of characteristics and early outcomes for patients listed and following pediatric HTx with COVID-19. Hospitalization appears to be more common for both candidates and recipients due to COVID-19 than for the general pediatric population though stays were short and mortality minimal.
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SARS-CoV-2 infection in heart transplant recipients: a systematic literature review of clinical outcomes and immunosuppression strategies. Heart Fail Rev 2021; 27:1653-1663. [PMID: 34671872 PMCID: PMC8528562 DOI: 10.1007/s10741-021-10181-y] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2021] [Indexed: 12/15/2022]
Abstract
The impact of SARS-CoV-2 infection on heart transplant recipients is unknown. Literature is limited to case reports and series. The purpose of this study is to identify the clinical features, outcomes, and immunosuppression strategies of heart transplant recipients with COVID-19 infection. A systematic review was conducted using the search term "Coronavirus" or COVID," "SARS-CoV-2," "cardiac transplantation," and "heart transplant." Case reports and retrospective studies were gathered by searching Medline/PubMed, Google Scholar, CINAHL, Cochrane CENTRAL, and Web of Science. Thirty-three articles were selected for review. We identified 74 cases of SARS-CoV-2 infection in heart transplant and heart-kidney transplant recipients. The mean age was 60.5 ± 15.8 years, and 82.4% were males with median time from transplant of 6.5 years. Commonest symptoms were fever, cough, and dyspnea, but new left ventricular (LV) dysfunction was rare. Leukocytosis, lymphopenia, elevated inflammatory markers, and bilateral ground-glass opacities were common. Mortality was high, with particularly poor survival in patients who required intensive care unit (ICU) admission and older patients. Immunosuppression involved discontinuation of antimetabolites and steroids. COVID-19 infection in heart transplant (HT) recipients presents similarly to the general population, but new onset of LV dysfunction is uncommon. Immunosuppression strategies include increase in corticosteroids and discontinuation of antimetabolites.
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Erbel‐Khurtsidze S, Immohr MB, Akhyari P, Tudorache I, Aubin H, Bruno RR, Westenfeld R, Feldt T, Lübke N, Lichtenberg A, Boeken U. Adequate immune response after SARS-CoV-2 infection and single dose vaccination despite rapid heart transplantation. ESC Heart Fail 2021; 8:5568-5571. [PMID: 34608773 PMCID: PMC8652618 DOI: 10.1002/ehf2.13635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/03/2021] [Accepted: 09/13/2021] [Indexed: 11/07/2022] Open
Abstract
Adequate immune response to vaccination remains a challenge in patients after solid organ transplantation. We report a case of a 61-year-old male patient who received a left ventricular assist device as a bridge to transplant therapy. Three months before transplantation, he suffered mild SARS-CoV-2 infection and was successfully discharged thereafter. Eight days before his successful heart transplantation, he received mRNA BNT 162b2 vaccination. Immediately after transplantation, we detected sufficient rise of nucleocapsid and spike antibodies despite immune suppression therapy. We suspect potential booster effects of the previous SARS-CoV-2 infection giving rise to adequate immune response following single vaccination.
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Affiliation(s)
- Sophiko Erbel‐Khurtsidze
- Department of Cardiac Surgery, Medical Faculty and University Hospital DüsseldorfHeinrich‐Heine‐University DüsseldorfMoorenstrasse 5Duesseldorf40225Germany
| | - Moritz Benjamin Immohr
- Department of Cardiac Surgery, Medical Faculty and University Hospital DüsseldorfHeinrich‐Heine‐University DüsseldorfMoorenstrasse 5Duesseldorf40225Germany
| | - Payam Akhyari
- Department of Cardiac Surgery, Medical Faculty and University Hospital DüsseldorfHeinrich‐Heine‐University DüsseldorfMoorenstrasse 5Duesseldorf40225Germany
| | - Igor Tudorache
- Department of Cardiac Surgery, Medical Faculty and University Hospital DüsseldorfHeinrich‐Heine‐University DüsseldorfMoorenstrasse 5Duesseldorf40225Germany
| | - Hug Aubin
- Department of Cardiac Surgery, Medical Faculty and University Hospital DüsseldorfHeinrich‐Heine‐University DüsseldorfMoorenstrasse 5Duesseldorf40225Germany
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital DüsseldorfHeinrich‐Heine‐University DüsseldorfDuesseldorfGermany
| | - Ralf Westenfeld
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital DüsseldorfHeinrich‐Heine‐University DüsseldorfDuesseldorfGermany
| | - Torsten Feldt
- Department of Gastroenterology, Hepatology and Infectious Diseases, Medical Faculty and University Hospital DüsseldorfHeinrich‐Heine‐University DüsseldorfDuesseldorfGermany
| | - Nadine Lübke
- Institute of Virology, Medical Faculty and University Hospital DüsseldorfHeinrich‐Heine‐University DüsseldorfDuesseldorfGermany
| | - Artur Lichtenberg
- Department of Cardiac Surgery, Medical Faculty and University Hospital DüsseldorfHeinrich‐Heine‐University DüsseldorfMoorenstrasse 5Duesseldorf40225Germany
| | - Udo Boeken
- Department of Cardiac Surgery, Medical Faculty and University Hospital DüsseldorfHeinrich‐Heine‐University DüsseldorfMoorenstrasse 5Duesseldorf40225Germany
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Meshram HS, Kute VB, Patel HV, Hegde U, Das P, Sil K, Sahay M, Raju SB, Chaudhury AR, Siddini V, Pathak V, Bahadur M, Anand U, Krishna A, Abraham A, Patel AH, Mishra V, Chauhan S. Is Early COVID-19 in Kidney Transplant Recipients Concerning Enough to Halt Transplantation? A Multicenter Comparative Analysis from India. Transplant Proc 2021; 53:2468-2475. [PMID: 34556343 PMCID: PMC8403672 DOI: 10.1016/j.transproceed.2021.08.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 08/24/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Limited data exist on the incidence and outcome of early coronavirus disease 2019 (COVID-19) in kidney transplantation recipients (KTR). METHODS A retrospective multicenter research study was conducted across 12 centers in India. We explored the symptomatology, demographic, laboratory findings, and outcome of COVID-19 within 30 days of transplantation. The outcome was compared with the overall KTR and waitlisted patients acquiring COVID-19. RESULTS The incidence of early COVID-19 was 2.6% (n = 22) for the cumulative 838 renal transplants performed since nationwide lockdown in March 2020 until May 2021. Overall, 1049 KTR were diagnosed with COVID-19 and 2% of those had early COVID-19. The median age of the early COVID-19 cohort was 43 (31-46) years. COVID-19 severity ranged from asymptomatic (18.2%), mild (59.1%), moderate (9.1%), and severe (13.6%). Among clinical symptoms, dyspnea and anosmia were frequent, and in laboratory parameters, neutrophil lymphocyte ratio, high-sensitivity C-reactive protein, and D-dimer were higher in patients requiring oxygen. The mortality in early COVID-19 was not higher than overall KTR (4.5% vs 8.5%; P = 1). COVID-19 severity (23.9% vs 15.7%; P = .0001) and mortality (15.5% vs 8.5%; P = .001) among waitlisted patients (n = 1703) were higher compared with overall KTR. CONCLUSIONS We report higher burden of COVID-19 in waitlisted patients compared with KTR and a favorable outcome in early COVID-19 in KTR. Our report will help the transplant physicians in dealing with the ongoing dilemma of halting or resuming transplantation in the COVID-19 era.
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Affiliation(s)
- Hari Shankar Meshram
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Vivek B. Kute
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India,Address correspondence to Vivek B. Kute, MD, DM, FCPS, FASN, FISOT, FISN, FRCP, Department of Nephrology and Clinical Transplantation, Institute of Kidney Diseases and Research Centre, Dr. H. L. Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India. Tel.: +91 9099927543
| | - Himanshu V. Patel
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Umapati Hegde
- Department of Nephrology, Muljibhai Patel Urological Hospital, Nadiad, Gujarat, India
| | - Pratik Das
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal
| | - Keshab Sil
- Department of Nephrology, Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal
| | - Manisha Sahay
- Department of Nephrology, Osmania General Hospital, Hyderabad, India
| | - Sree Bhushan Raju
- Department of Nephrology, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, India
| | - Arpita Ray Chaudhury
- Department of Nephrology, Institute of Post-Graduate Medical Education & Research, Kolkata, India
| | | | - Vivek Pathak
- Department of Nephrology, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
| | - M.M. Bahadur
- Department of Nephrology, Jaslok Hospitals, Mumbai, India
| | - Urmila Anand
- Departmentt of Nephrology, Centre Yashoda Hospitals, Secunderabad, India
| | - Amresh Krishna
- Department of Nephrology and Renal Transplantation, Indira Gandhi Institute of Medical Science, Patna, India
| | | | - Ansy H. Patel
- B. J. Medical Hospital, Civil Hospital, Ahmedabad, Gujarat, India
| | - Vineet Mishra
- Department of Gynecology, Institute of Kidney Diseases and Research Centre, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Sanshriti Chauhan
- Department of Nephrology, Institute of Kidney Diseases and Research Centre, Dr. H. L. Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
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Martens T, Hens L, De Pauw M, Van Belleghem Y. Heart transplantation complicated by COVID-19 infection. Ann Thorac Surg 2021; 113:e267-e269. [PMID: 34283959 PMCID: PMC8285367 DOI: 10.1016/j.athoracsur.2021.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 11/30/2022]
Abstract
The influence of Coronavirus-2019 (COVID-19) on heart transplantation is considerable. Reports of COVID-19 infection in recently transplanted patients are scarce. We present a 60-year-old male patient with COVID-19 infection, diagnosed 6 days after transplantation. His clinical course revealed 2 phases. Initially, there were mild respiratory symptoms for which he was treated with remdesivir and noninvasive respiratory support. In a second phase with clinical deterioration on postoperative day 22, further respiratory decline led to the administration of convalescent plasma, with satisfactory response and further improvement of his condition.
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Affiliation(s)
- Thomas Martens
- Department of Cardiac Surgery, Ghent University Hospital, Belgium.
| | - Lineke Hens
- Department of Cardiology, Ghent University Hospital, Belgium
| | - Michel De Pauw
- Department of Cardiology, Ghent University Hospital, Belgium
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