Investigations into the presentation and prognosis of the novel coronavirus disease 2019 (COVID-19) in patients who have received a heart transplant are needed, according to an editorial published in The Journal of Heart and Lung Transplantation.
Mortality rates associated with COVID-19 increase sharply with age, and immunosuppressed individuals are among those at higher risk for severe illness. However, the presentation and prognosis of COVID-19 in heart transplant recipients has not been adequately reported, and it remains uncertain whether immunosuppression related to transplantation alters predisposition to infection with severe acute respiratory syndrome–coronavirus-2 (SARS-CoV-2).
Immunosuppression in transplant patients has anti-inflammatory effects which may diminish the clinical presentation of the disease. In addition, expression of the angiotensin-converting enzyme-2 to which COVID-19 binds in the lung may be affected in patients who have received a heart transplant, also leading to milder symptoms.
The first confirmed cases of COVID-19 in patients who received heart transplantation had variable disease severity, with one patient experiencing a mild infection and another requiring a prolonged hospitalization due to severe clinical manifestations. Both patients survived the infection.
Immunosuppressed patients may be more prone to infection with COVID-19, and should be advised on proper mitigation strategies to prevent infection, such as social distancing and hand hygiene.
Heart donors should be tested for the virus, and the suitability of hearts for transplantation from individuals who have been infected with COVID-19 should be carefully assessed.
“[T]he novel coronavirus and its disease, COVID-19, require thoughtful approaches for the prevention, mitigation, timely detection and appropriate therapeutic intervention for our vulnerable patients,” the authors noted. “At this time, it would be prudent to avoid transplanting organs from donors with a history of contact with someone at risk or diagnosed with COVID-19 as well as those with recent travel to an area with high density of infection.”
Disclosure: Dr Aslam and Dr Mehra reported affiliations with the pharmaceutical industry. Please see the original reference for a full list of disclosures.
Aslam S, Mehra MR. COVID-19: Yet another coronavirus challenge in transplantation [published online March 14, 2020]. J Heart Lung Transplant. doi:10.1016/j.healun.2020.03.007