Abstract
PURPOSE: Reduction in immunosuppression (IS) is universally recommended in the setting of infection, but its effect on outcomes in the setting of COVID-19 has not been established. The purpose of this study is to characterize the impact of IS reduction strategies on disease severity and outcomes of COVID infection in heart transplant patients (HTPs). METHODS: This was a single center, retrospective review of HTPs with COVID infection managed inpatient or outpatient, examined in cohorts by approach to IS reduction. Demographics, severity at diagnosis and peak based on NIH Classification of COVID Illness Severity, and secondary clinical outcomes were collected (Table 1). The primary outcome was the difference in COVID severity score after IS regimen changes at time of diagnosis. Descriptive statistics, ANOVA, independent t-tests, and chi square analyses were used to evaluate baseline characteristics, primary outcome, and secondary outcomes. RESULTS: Data was collected for 110 patients with 113 COVID infections between March 2020 and June 2022. Patients were on average 54 years old, 75% white, 15% Hispanic ethnicity, and 5 years post HT at the time of their infection. Approaches to IS changes were antimetabolite (antiM) reduction (62%), all IS reduced (6%), or no change (32%). There was a significant difference in clinical severity from diagnosis to peak across all groups (p = 0.004), contributed largely by the All IS Reduced group with significantly higher peak severity (p = 0.002) leading to drastic IS reductions. In a sub-analysis to compare the protocolized approach of antiM reduction to no change in IS, no difference was noted in mortality, superimposed infections, or treated graft rejection (Table 1). Change in severity of infection over time is noted by variant in Figure 1. CONCLUSION: As COVID vaccination and therapeutic agents evolve, drastic IS modifications may not be necessary if baseline infection is mild. However, reduced duration IS reduction did not lead to more treated graft rejection.