Coronavirus Disease 2019 Outcomes in Heart Transplant Recipients

A Single-center Case Series

Farah Naghashzadeh; Shadi Shafaghi; Babak Sharif-Kashani; Payam Tabarsi; Leila Saliminejad; Sima Noorali


J Med Case Reports. 2021;15(453) 

In This Article

Abstract and Introduction


Background: With the rapidly expanding pandemic of severe acute respiratory syndrome coronavirus-2, a chronic immunosuppressed state in solid organ transplant recipients is a concern. We reported coronavirus disease 2019 in heart transplant recipients and described the patients' course from diagnosis to either hospital admission or improvement in symptoms.

Case Presentation: This study retrospectively identified 13 white (Iranian) heart transplant patients with coronavirus disease 2019 between December 2019 and October 2020. The mean age of patients was 43.7 years (19–65 years); seven (70%) were men. Laboratory and treatment data were collected for those admitted or managed as outpatients. Outcomes were also recorded for all patients. This report demonstrates a range of symptoms, clinical severity, and disease course in heart transplant recipients with coronavirus disease 2019, including ten hospitalized patients and three patients, managed entirely in the outpatient setting. One patient passed away, and none of them experienced an episode of clinically overt rejection.

Conclusions: We would like to emphasize the importance of being alert in these patients to consider testing in a broad range of clinical presentations and gathering more data for better management.


The recently novel coronavirus, severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), emerged in China in December 2019 and caused a highly contagious disease called coronavirus disease 2019 (COVID-19).[1] In less than 3 months, it spread throughout the globe and was declared a global pandemic by the World Health Organization on 11 March 2020.[2] To date, COVID-19 has affected over 9 million people worldwide. The clinical manifestations of COVID-19 range from minimally symptomatic individuals to severe courses with the requirement of invasive mechanical ventilation and multiorgan failure.[3,4]

Risk factors for morbidity and mortality include older age, cardiovascular disease, diabetes, chronic respiratory disease, hypertension, obesity, and cancer. A particular concern also exists regarding the vulnerability of pharmacologically immunosuppressed patients before or during this pandemic.[3,5] Thus, solid organ transplant (SOT) recipients, including heart transplant (HTx) recipients, are considered to be vulnerable to COVID-19 infection because of immunosuppression and the presence of comorbidities. Epidemiologic and clinical characteristics of HTx recipients during the SARS-CoV-2 pandemic are largely unknown.[6]

The following report describes 13 cases of HTx recipients with laboratory-confirmed SARS-CoV-2 and reviews the clinical presentations, treatment strategies, and short-term outcomes.