Impact of COVID-19 Infection Among Heart Transplant Recipients: A Southern Brazilian Experience

Fernando Luis Scolari; Laura Caroline Tavares Hastenteufel; Lídia Einsfeld; Julia Bueno; Letícia Orlandin; Nadine Clausell; Lívia Adams Goldraich

doi:10.3389/fmed.2022.814952

Impact of COVID-19 Infection Among Heart Transplant Recipients: A Southern Brazilian Experience

Front Med (Lausanne). 2022 Feb 9:9:814952. doi: 10.3389/fmed.2022.814952. eCollection 2022.

Authors

Fernando Luis Scolari^{1

2}, Laura Caroline Tavares Hastenteufel³, Lídia Einsfeld⁴, Julia Bueno⁵, Letícia Orlandin¹, Nadine Clausell^{1

5}, Lívia Adams Goldraich¹

Affiliations

¹ Heart Transplant Program, Division of Cardiology, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
² Ted Rogers Center for Heart Research, Peter Munk Cardiac Center, University Health Network, Toronto, ON, Canada.
³ Division of Internal Medicine, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
⁴ Pharmacy Service, Clinical Pharmacy Section, Hospital de Clinicas de Porto Alegre, Porto Alegre, Brazil.
⁵ Faculty of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

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.

Keywords: Brazil; COVID-19; heart transplant; immunosuppression; infection.