P2A091: Incidence and Sequelae of COVID-19 in Patients with History of Heart Transplant; A Single-center Study

Background: Though individuals with solid-organ transplant are considered to be at higher risk of contracting COVID-19, the incidence and outcomes of COVID-19 infection amongst pediatric heart transplant recipients is not well known. It has been established that those with pre-existing cardiovascular disease have poorer prognosis of COVID-19 infection than those who were previously healthy. Additionally, COVID-19 itself is known to have myriad risk of cardiovascular sequelae. Given these concerns, understanding the outcomes of patients with history of heart transplant is critical. The goal of this study is to evaluate the impact of COVID-19 in a pediatric heart transplant population at a single center.

Methods: We conducted a single-center, retrospective cohort study over a period of 3 years from January 1, 2020 until December 31, 2022. Pediatric Heart transplant recipients followed in our transplant clinic and documented COVID-19 positive testing were included. Descriptive analyses of time since transplant at the time of contracting COVID, timing of rejection in relation to COVID diagnosis, and hospitalization secondary to COVID-19 infection was performed, along with frequencies of patient demographics, immunosuppressive agents used, vaccination status, cardiac functional change, and development of de novo antibodies.

Results: Of a total of 45 heart transplant patients, 22 (48.8%) had documentation of COVID-19 positivity. All patients were exposed in the community, and all returned to baseline functional status. The COVID-19 positive patients ranged from 4 to 27 years old. They contracted COVID at 3 months to 20 years from transplant. 5 (22.7%) patients were on tacrolimus monotherpay at the time of infection, while the rest were maintained on dual-agents. 8 (36.4%) patients with COVID positivity were hospitalized. Illness severity ranged significantly. 3 of the 8 hospitalized (37.5%) had elective admission for remdesivir. One patient required mechanical ventilatory and ionotropic support. The same patient also experienced clinical rejection. 4 (18.2%) were treated for rejection within 6 months of COVID positivity. 31.8% (7 patients) developed de novo donor-specific antibodies with no other explanation; one of those patients developed Class I antibodies alone, while the rest developed Class II DSAs.

Conclusion: Reports focused on adult data infer that cardiac transplant patients who contract COVID-19 are at higher risk of severe disease, however, this has not yet been definitively described in the pediatric heart transplant population. Our cohort had no mortality, and all patients returned to their baseline functional status. Even among hospitalized patients, the need for ICU level care was minimal. Some patients did require treatment for rejection, and several also developed de novo DSAs. The significance of these developments has yet to be seen.