Early experience of COVID-19 in 2 heart transplant recipients: Case reports and review of treatment options

Am J Transplant. 2020 Oct;20(10):2916-2922. doi: 10.1111/ajt.15982. Epub 2020 May 22.


The coronavirus disease 2019 (COVID-19) pandemic poses special challenges to immunocompromised transplant patients. Given the paucity of proven data in treating COVID-19, management of these patients is difficult, rapidly evolving, and mainly based on anecdotal experience. We report 2 cases of heart transplant (HT) recipients with COVID-19. The first is a 59-year-old female with HT in 2012 who presented on March 20, 2020 with fever, hypoxia, and ground-glass opacities on chest X-ray. She quickly progressed to acute hypoxic respiratory failure and vasoplegic shock. Despite reduction in immunosuppression and treatment with tocilizumab, intravenous immunoglobulin, hydroxychloroquine, lopinavir/ritonavir, and broad-spectrum antibiotics, she ultimately died from multiorgan failure. The second case is a 75-year-old man with HT in 2000 who presented on April 2, 2020 after curbside testing revealed positive COVID-19. Given a milder presentation compared to the first patient, antimetabolite was discontinued and only hydroxychloroquine was started. Because of a lack of clinical improvement several days later, tocilizumab, methylprednisolone, and therapeutic anticoagulation were initiated. The patient clinically improved with decreasing oxygen requirements and was discharged home. These 2 cases highlight the wide range of different presentations of COVID-19 in HT recipients and the rapidity with which the management of these patients is evolving.

Keywords: clinical research/practice; complication: infectious; drug toxicity; heart (allograft) function/dysfunction; heart transplantation/cardiology; immunosuppressant; infection and infectious agents - viral; infectious disease; pharmacology.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Betacoronavirus*
  • COVID-19
  • Comorbidity
  • Coronavirus Infections / epidemiology*
  • Fatal Outcome
  • Female
  • Graft Rejection / prevention & control*
  • Humans
  • Immunocompromised Host
  • Immunosuppression Therapy / methods
  • Immunosuppressive Agents / therapeutic use*
  • Kidney Failure, Chronic / epidemiology
  • Kidney Failure, Chronic / surgery*
  • Kidney Transplantation / adverse effects*
  • Male
  • Middle Aged
  • Pandemics
  • Pneumonia, Viral / epidemiology*
  • SARS-CoV-2
  • Transplant Recipients*


  • Immunosuppressive Agents