Coronavirus disease 2019 in heart transplant recipients: Risk factors, immunosuppression, and outcomes

Michael V. Genuardi, Noah Moss, Samer S. Najjar, Brian A. Houston, Supriya Shore, Esther Vorovich, Pavan Atluri, Maria Molina, Susan Chambers, Tiffany Sharkoski, Eileen Hsich, Jerry D. Estep, Anjali T. Owens, Kevin M. Alexander, Sunit Preet Chaudhry, Rafael Garcia-Cortes, Ezequiel Molina, Maria Rodrigo, MDc Joyce Wald, Kenneth B. MarguliesThomas C. Hanff, Ross Zimmer, Arman Kilic, Rhondalyn Mclean, Himabindu Vidula, Katherine Dodd, Emily A. Blumberg, Jeremy A. Mazurek, Lee R. Goldberg, Jesus Alvarez-Garcia, Donna Mancini, Jeffrey J. Teuteberg, Ryan J. Tedford, Edo Y. Birati

Research output: Contribution to journalArticlepeer-review

35 Scopus citations


Background: COVID-19 continues to inflict significant morbidity and mortality, particularly on patients with preexisting health conditions. The clinical course, outcomes, and significance of immunosuppression regimen in heart transplant recipients with COVID-19 remains unclear. Methods: We included the first 99 heart transplant recipients at participating centers with COVID-19 and followed patients until resolution. We collected baseline information, symptoms, laboratory studies, vital signs, and outcomes for included patients. The association of immunosuppression regimens at baseline with severe disease were compared using logistic regression, adjusting for age and time since transplant. Results: The median age was 60 years, 25% were female, and 44% were white. The median time post-transplant to infection was 5.6 years. Overall, 15% died, 64% required hospital admission, and 7% remained asymptomatic. During the course of illness, only 57% of patients had a fever, and gastrointestinal symptoms were common. Tachypnea, oxygen requirement, elevated creatinine and inflammatory markers were predictive of severe course. Age ≥ 60 was associated with higher risk of death and the use of the combination of calcineurin inhibitor, antimetabolite, and prednisone was associated with more severe disease compared to the combination of calcineurin inhibitor and antimetabolite alone (adjusted OR = 7.3, 95% CI 1.8-36.2). Among hospitalized patients, 30% were treated for secondary infection, acute kidney injury was common and 17% required new renal replacement therapy. Conclusions: We present the largest study to date of heart transplant patients with COVID-19 showing common atypical presentations and a high case fatality rate of 24% among hospitalized patients and 16% among symptomatic patients.

Original languageEnglish
Pages (from-to)926-935
Number of pages10
JournalJournal of Heart and Lung Transplantation
Issue number9
StatePublished - Sep 2021

Bibliographical note

Publisher Copyright:
© 2021 International Society for Heart and Lung Transplantation


  • coronavirus disease 2019
  • epidemiology
  • heart transplant
  • hospitalization
  • mortality
  • outcomes


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