Table 1.
Characteristics of SARS-CoV-2–Positive Heart Transplant Recipients
| Patient 1 | Patient 2 | Patient 3 | Patient 4 | Patient 5 | Patient 6 | |
|---|---|---|---|---|---|---|
| Sex, age, y, ethnicity/race | Male, 65, White | Male, 56, White | Female, 66, White | Male, 41, White | Female, 47, Asian (Indian) | Male, 41, White |
| Organ(s) transplanted (UNOS status) | Heart (4) and kidney | Heart (4) | Heart (3) | Heart (2) | Heart (6) | Heart (4) |
| Previous cardiac surgeries/procedure | CABG | ICD and cardiac resynchronization therapy device | Tricuspid valve repair. 3 ablations for AVNRT and atrial fibrillation |
ICD and intra-aortic balloon pump × 2 | None | ICD |
| Pretransplant organ failure data | ||||||
| Ejection fraction (%) | 18 | 38 | 45 | 19 | 15 | 25 |
| Cardiac index (L/min/m2) | 1.96 | 2.20 | 1.72 | 2.46 | 2.10 | 2.31 |
| Glomerular filtration rate stage | Stage 4 | Stage 2 | Stage 3a | Stage 2 | Stage 3 | Stage 1 |
| COVID-19 data | ||||||
| COVID-19 vaccination status | 3 doses: third dose (BNT162b2) 1 wk prior | 2 doses: second dose (BNT162b2) 14 wk prior |
2 doses: second dose (mRNA-1273) 27 wk prior | 3 doses: third dose (mRNA-1273) 10 wk prior | 3 doses: third dose (BNT162b2) 25 wk prior | 3 doses: third dose (mRNA-1273) 40 wk prior |
| Previous COVID-19 infection | Not reported | Not reported | Not reported | Not reported | Not reported | Not reported |
| SARS-CoV-2 testing posttransplant | Negative on PODs 3.5,7 | Negative on POD 9 | Negative on PODs 3, 7, 14 | Negative on PODs 3, 5, 7 | Negative on POD 3 | Negative on POD 18, 33 |
| Transplant | ||||||
| Cardiopulmonary bypass time (min) | 134 | 164 | 163 | 112 | 236 | 230 |
| Total donor organ ischemic time (min) | 204 | 170 | 157 | 180 | 201 | 97 |
| Immunosuppressive treatment | ||||||
| Induction | rATG | rATG, methylprednisolone | Basiliximab, methylprednisolone | rATG | rATG, methylprednisone | Basiliximab, methylprednisolone |
| Regimen | Mycophenolate, prednisone, tacrolimus | Mycophenolate, prednisone, tacrolimus | Mycophenolate, prednisone, tacrolimus | Mycophenolate, prednisone, tacrolimus | Mycophenolate, prednisone, tacrolimus | Mycophenolate, prednisone, tacrolimus |
| Outcome | Heart retransplant on POD 31. Biopsy of explanted heart showed diffuse myocyte injury and pericarditis. Death on POD 156 | Discharged home on POD 34 | Discharged to an inpatient rehabilitation center on POD 35. Discharged home on POD 48. Third dose of mRNA-1273 3 mo after transplant | Discharged home on POD 11 | Discharged home on POD 21. Fourth dose of BNT162b2 vaccine 2 wk after transplant | Discharged home on POD 9 |
| Post-transplant endomyocardial biopsy* | Total: 3. All negative for rejection |
Total: 11. No. 5 showed moderate ACMR The rest showed mild ACMR |
Total: 10. No. 1, 3, 7, 8, 9 showed mild ACMR. The rest were negative |
Total: 10. No. 5, 6, 7, 8, 9 showed mild ACMR. The rest were negative. |
Total: 6. All negative for rejection |
Total: 4. All showed mild ACMR |
ACMR, acute cell-mediated rejection; AVNRT, atrioventricular nodal reentrant tachycardia; CABG, coronary artery bypass graft; EMB, endomycardial biopsy; ICD, implantable cardioverter-defibrillator; POD, postoperative day; rATG, rabbit antithymocyte immunoglobulin; UNOS, United Network for Organ Sharing.
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For patient 1, we consider EMBs obtained after his second heart transplant.