Patients from Hubei province in China offer look at how virus may impact patients
ADDISON, Texas – March 26, 2020 – The Journal of Heart and Lung Transplantation released the first report examining the impact of COVID-19 on two heart transplant recipients who contracted the virus in their native China. The study, the first of its kind globally, may provide insight into how the virus will impact transplant recipients around the world, say the editorialists, Saima Aslam, MD, MS Division of Infectious Diseases and Global Public Health at the University of California, San Diego, and Mandeep R. Mehra, MD, MSc, Center for Advanced Heart Disease, Brigham and Women’s Hospital and Harvard Medical School, Boston.
The two patients presented with varied levels of severity -- one mild, the other more severe and requiring prolonged hospitalization. Both patients survived the event. They were managed uniquely with changes in immunosuppression and the selective use of anti-viral and immunomodulatory therapy.
“We’ll need to study a broader pool of patients, but it’s possible that, among heart transplant recipients, the anti-inflammatory effects of immunosuppression actually lessen the expression of COVID-19 into its severe stages,” said Dr. Mehra.
Presentation of the virus
Both patients presented in ways similar to non-immunosuppressed people who contracted the virus: fever, chills. In addition, the laboratory findings mirrored those observed in non-transplant patients with elevated C-Reactive Protein levels and lymphopenia suggesting that lessons learned from non-transplanted patients may also apply to these patients.
Treating the patients
The treatment for the patient with severe disease included withholding baseline immunosuppression and treating with high dose corticosteroids and pooled immunoglobulin infusions. A “kitchen-sink” approach to the cases also included the use of a fluroquinolone along with ganciclovir, but, with such a limited patient pool, the researchers can’t be certain what impact that approach had.
The patients recovered to discharge without incurring immunological consequences on the cardiac allograft and remained rejection-free.
Reasons for recovery
In Coronavirus patients, the system is overpowered by SARS-CoV-2, causing pulmonary inflammatory infiltrates to emerge and express the COVID-19 disease phenotype. It is unknown if heart transplant recipients have differential expression of pulmonary ACE-2, since a lower expression may result in less severe illness. Similarly, the anti-inflammatory effects of immunosuppression could diminish the clinical expression of disease as well.
The International Society for Heart and Lung Transplantation is a not-for-profit, multidisciplinary professional organization dedicated to improving the care of patients with advanced heart or lung disease through transplantation, mechanical support and innovative therapies. With more than 3,800 members in more than 45 countries, ISHLT is the world’s largest organization dedicated to the research, education and advocacy of end-stage heart and lung disease. ISHLT members represent more than 15 different professional disciplines. For more information, visit www.ishlt.org.