COVID-19 among heart transplant recipients in Germany: a multicenter survey

Clin Res Cardiol. 2020 Dec;109(12):1531-1539. doi: 10.1007/s00392-020-01722-w. Epub 2020 Aug 11.


Aims: Heart transplantation may represent a particular risk factor for severe coronavirus infectious disease 2019 (COVID-19) due to chronic immunosuppression and frequent comorbidities. We conducted a nation-wide survey of all heart transplant centers in Germany presenting the clinical characteristics of heart transplant recipients with COVID-19 during the first months of the pandemic in Germany.

Methods and results: A multicenter survey of all heart transplant centers in Germany evaluating the current status of COVID-19 among adult heart transplant recipients was performed. A total of 21 heart transplant patients with COVID-19 was reported to the transplant centers during the first months of the pandemic in Germany. Mean patient age was 58.6 ± 12.3 years and 81.0% were male. Comorbidities included arterial hypertension (71.4%), dyslipidemia (71.4%), diabetes mellitus (33.3%), chronic kidney failure requiring dialysis (28.6%) and chronic-obstructive lung disease/asthma (19.0%). Most patients received an immunosuppressive drug regimen consisting of a calcineurin inhibitor (71.4%), mycophenolate mofetil (85.7%) and steroids (71.4%). Eight of 21 patients (38.1%) displayed a severe course needing invasive mechanical ventilation. Those patients showed a high mortality (87.5%) which was associated with right ventricular dysfunction (62.5% vs. 7.7%; p = 0.014), arrhythmias (50.0% vs. none; p = 0.012), and thromboembolic events (50.0% vs. none; p = 0.012). Elevated high-sensitivity cardiac troponin T- and N-terminal prohormone of brain natriuretic peptide were significantly associated with the severe form of COVID-19 (p = 0.017 and p < 0.001, respectively).

Conclusion: Severe course of COVID-19 was frequent in heart transplanted patients. High mortality was associated with right ventricular dysfunction, arrhythmias, thromboembolic events, and markedly elevated cardiac biomarkers.

Keywords: COVID-19; Heart transplantation; Immunosuppression; Mortality.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • COVID-19 / epidemiology*
  • COVID-19 / immunology
  • COVID-19 / mortality
  • COVID-19 / therapy
  • Female
  • Germany / epidemiology
  • Health Care Surveys
  • Heart Transplantation / adverse effects*
  • Humans
  • Immunocompromised Host
  • Immunosuppressive Agents / adverse effects*
  • Male
  • Middle Aged
  • Opportunistic Infections / epidemiology*
  • Opportunistic Infections / immunology
  • Opportunistic Infections / mortality
  • Opportunistic Infections / therapy
  • Risk Factors
  • Time Factors
  • Transplant Recipients
  • Treatment Outcome


  • Immunosuppressive Agents