Abstract
PURPOSE: To evaluate the evolution of COVID infection in heart transplant recipients (HT). METHODS: Prospective, single-center observational study including all HT at risk for COVID infection between March 1st, 2020 and August 31th, 2022. We analyzed their baseline characteristics, COVID clinical presentations, and the variation in COVID prognosis over time. RESULTS: Of 309 HT, 121 had COVID infection. Baseline characteristics were similar among COVID and non-COVID HT. Most HT were on standard triple immunosuppression therapy in both groups. COVID HT with pneumonia were older (63±12 vs. 55±15 years, p <0.01), had more frequently chronic kidney (62.9% vs. 24.4%, p<0.01) and lung disease (22.9% vs. 7.0%, p=0.03), and were taking cyclosporine at a higher rate (65.7% vs. 32.6%, p<0.01). In addition, fewer of them were fully vaccinated (45.7% vs. 70.9%, p=0.05). COVID HT with pneumonia presented more frequently dyspnea (45.7% vs. 7.0%, p<0.01) and fever (77.1% vs. 29.1%, p<0.01), deeper lymphopenia (647 ± 420 vs. 972 ± 553 U/µl, p=0.02), and higher C-reactive protein (2.0±1.9 vs. 8.0±4.9 mg/dL, p<0.01). Most of them were admitted (94.3% vs. 16.3%, p<0.01), and required oxygen therapy (65.7%), noninvasive (34.3%) or invasive ventilation (20.0%). Their mortality was 33 times higher than that of patients without pneumonia (40% vs. 1.2%, p<0.01).There were 11 reinfections, 2 with pneumonia in nonvaccinated patients. One died, and the other 10 recovered. The image shows the impact of COVID infection over time in our HT population. Three factors have potentially contributed to improving the prognosis: high vaccination rate, early treatment with remdesivir, and omicron expansion as the main COVID variant. CONCLUSION: HT are at high risk for severe COVID infection. Older age and greater comorbidity increase the risk of pneumonia, with poor prognosis. Vaccination, remdesivir treatment and omicron spread seem to have improved the prognosis in recent times.