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Last Update: 18 - 01 - 2023 (628506 entries)
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| Title | Venue | Year | Impact | Source | |
|---|---|---|---|---|---|
| 3601 | Cytomegalovirus Infection Following Vaccination for COVID-19 in Thoracic Organ Transplant Recipients Purpose Cytomegalovirus (CMV) is one of the main causes of infection after solid organ transplantation but CMV infection after vaccination for COVID has not been previously reported. The purpose of our study was to study cases of CMV DNAemia noted after COVID-19 mRNA vaccination in our thoracic organ transplant recipients. Methods Between March 1, 2021, and June 30, 2021, we identified 7 cases of CMV infection in thoracic organ transplant recipients within 30 days of COVID-19 mRNA vaccination. Descriptive statistics was used to study these cases. Results Our findings are summarized in the table. Of our patients, 3 were lung recipients, 3 were heart recipients while one was a dual heart-kidney recipient. Three patients received the mRNA-1273 (Moderna) vaccine while others received the BNT162b2 (Pfizer) vaccine. Age ranged from 42 to 73 years. Two of the lung transplant recipients and one heart recipient were CMV high-risk status (Donor+/Recipient-), while the others were recipient-seropositive for CMV. The median time to PCR detection of CMV DNAemia from the second dose of mRNA vaccine was 16 days with a range of 4 days to 30 days. None of these recipients had post-transplant CMV infection detected previously. All patients were off antiviral prophylaxis and on their standard immunosuppressive regimen at the time of vaccination. Symptoms were variable but ranged from asymptomatic to acute respiratory failure. However, all patients had resolution of CMV DNAemia by the censor date with a range of 7 days to 45 days. Therapy included reduction of immunosuppression, intravenous ganciclovir, and oral valganciclovir. The median peak CMV DNA PCR in the cohort was 15,900 IU/ml with a range of 272 IU/ml to 175,973 IU/ml. None of the recipients developed IgG antibodies to SARS-CoV-2 in response to vaccination. There were no documented cases of COVID-19 in these transplant recipients. Conclusion CMV DNAemia after COVID-19 mRNA vaccination in solid organ transplant recipients may be an under-recognized phenomenon. Although the risk-benefit assessment strongly favors COVID-19 vaccination, due to the greater risk of adverse events with COVID-19 infection care teams should consider active monitoring for CMV disease activity in these patients. In some cases, CMV prophylaxis may be warranted depending on patients’ risk profile. Our findings warrant study in a larger prospective study. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3602 | Role of Immunosuppression on Efficacy of Anti-SARS-CoV-2 Vaccines in Heart Transplanted (HT) Patients Purpose Vaccines against COVID-19 have a lower efficacy in HT patients (pts); factors influencing their immunogenicity are unknown. The aim of this study is to investigate the role of immunosuppression on mRNA vaccines efficacy. Methods We included all HT pts followed in our Center completing the vaccine cycle (03-06/21), for whom levels of IgG anti-RBD after the second dose were known, excluding those with a previous COVID infection. Demography, immunosuppression (drugs and trough blood level), lymphocyte count, previous rejection episodes were collected before the first dose. The endpoint was vaccine-induced immunization after the second dose according to our laboratory's threshold of IgG anti-RBD. Results Among 201 vaccinated, IgG anti-RBD values were available for 63 pts at 2± 1 months after the second dose (22±3 days after the first; 89% BNT162b2; 60±11 yrs, 5±1 yrs from HT, 75% males, 3 with rejection > 1R in the previous 6 months). All pts were on CNI-inhibitors (35% tacrolimus, TAC, 65% cyclosporine, CyA), 57% on MMF, 23% mTOR, 69% steroids (CS). 41.7% had no response to vaccine. At univariate analysis the predictors of lack of response to vaccine were: MMF (43% vs 71%), TAC vs CSA (27% vs 73%), steroids (46% vs 76%), steroid dose > 5mg, lymphocytes <18% of leukocytes (both identified by ROC), more than 5 years from HT; mTOR was more likely associated with protection (80% vs 49%), p<0.05 all. Importantly, age was not predictive of immunogenicity. At stepwise multivariate analysis all these factors maintained statistical significance (p<0.05 all). IgG anti-RBD values were influenced by low lymphocytes, steroids and TAC trough levels (p< 0.05 all).Response to vaccine was the lowest for MMF+TAC+CS (23.1%), intermediate for MMF+CyA+CS (53.3%) and steroid-free regimens (68.7%), highest (87.5%) for mTOR+CNI+CS (20%,23%,24%,23% of pts, p=0.01). No rejection episodes were registered 3 months after the second dose of vaccine. Conclusion While confirming a low response to COVID-19 vaccines a in HT pts, our study underscores the negative effect of immunosuppression, particularly of MMF, high doses of steroids and TAC. Given that MMF is a cornerstone of most protocols, from these results it arises the hypothesis (to be tested in larger studies) if switching stable patients from TAC to Cya or to lower steroid doses may favor the attempts to increase the response to vaccines. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3603 | SARS-CoV-2 RNA in Explant Lung Tissue from Patients with COVID-19 ARDS Purpose Lung transplantation (LTx) can be considered in patients suffering from COVID-19 ARDS where lung recovery is unlikely. Exclusion of ongoing viral infection is an important condition to prevent COVID-19 transmission after LTx. Therefore, repeated negative SARS-CoV-2 PCR of bronchoalveolar lavage (BAL) samples is recommended. Using lungs removed during LTx for COVID-19 ARDS we aim to provide insight in the reliability of PCR on BAL samples for detection of SARS-CoV-2. Methods In two COVID-19 ARDS patients (A & B), we performed bilateral LTx 76 and 85 days after onset of COVID-19 symptoms. At least two PCR negative BAL samples were obtained prior to LTx: 33 and 73 days after onset in patient A; 61, 74 and 83 days after onset in patient B. After LTx, the removed right native lung was inflated and frozen. Per lung, 10 frozen biopsies from different regions in the three lobes were taken. For each biopsy, PCR targeting the SARS-CoV-2 Nucleocapsid (N) and subgenomic Envelope (sgE) RNA was performed. Results N-gene RNA was detected in both the upper, middle and lower lobes (figure). In patient A, 7 out of 10 biopsies were positive (Cycling threshold (Ct)=32.9-36.0). In patient B, 9 out of 10 biopsies were positive (Ct=29.9-33.1). PCR did not detect sgE-gene RNA in any biopsy. PCR Ct-values above 28 for N-gene RNA and no detection of sgE-gene RNA suggest absence of ongoing viral infection. After LTx, repeated PCR on BAL did not detect viral RNA in either recipient and both patients are currently doing well. Conclusion PCR on BAL fluid is considered a sensitive method to detect SARS-CoV-2. However, BAL sampling does not provide a complete picture on viral presence in the lung. After repeated negative PCR on BAL fluid, we proceeded with LTx in two patients with COVID-19 ARDS. Different lung regions still carried viral RNA, but there are no arguments that viral infection was still going on. Our understanding on the behavior and clinical relevance of persisting SARS-CoV-2 RNA, deep in the lung, is not complete and warrants further research. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3604 | Outcomes of SARS-CoV-2 Infection in Lung Transplant Recipients: A Single Center Experience Purpose Outcomes of Covid-19 in lung transplant recipients (LTr) were reported in the beginning of the pandemic. Only few centers reported on their experience since December 2020 when vaccines received emergency use authorization. We aim to investigate the outcome of SARS-CoV-2 infection in a cohort of LTr at our center in Detroit, Michigan. Methods Retrospective chart review study of adult LTr with confirmed SARS-CoV-2 infection from March 2020 to August 2021. Results Thirty LTr were diagnosed with SARS-CoV-2 infection confirmed by RT PCR of nasopharynx. Median age at diagnosis was 63; 53% were males; 57% Caucasians and 40% of African descendance. Most patients underwent bilateral LT for interstitial lung disease (46%) and for pulmonary sarcoidosis (23%). The median time post LT was 3.1 years. Most patients needed hospitalization for respiratory failure secondary to Covid-19 (73%). Eleven patients were initially managed as outpatient. Five patients received outpatient combination of monoclonal antibodies with three of them later requiring hospitalization for development of hypoxia. None of the patients with initial out of the hospital management died. Amongst 21 hospitalized LTr, six patients were diagnosed with severe pneumonia and ARDS requiring heated high flow and invasive mechanical ventilation (IMV) in 4 patients. 28-day mortality was 10% and ICU mortality was 25% (50% mortality in those on IMV). Twelve hospitalized patients (57%) were treated with remdesivir. Augmented systemic corticosteroids was used in 85% of cases. Cycle cell inhibitor was held in 71% of the cases. Bilateral ground glass opacities of the allografts were common. None of the patients that received at least one dose of mRNA vaccine died. Conclusion Outcomes in LTr infected with SARS-CoV-2 varies. Early reports showed high mortality rate in severe and critical Covid-19 in LTr. Although hospitalization rate in this cohort was high, only four patients in our cohort required IMV during acute Covid-19. Two of them died; both were unvaccinated. Another unvaccinated patient died due to allograft rejection two months after testing positive to SARS-CoV-2. Most cases were mild to moderate despite frequent radiographic findings of pneumonia. Underreporting and exclusion of mild cases as well as likely protective effect of vaccination and use of monoclonal antibodies may explain our different outcomes. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3605 | Effect of SARS-CoV-2 Infection on Anti-HLA Antibodies and De Novo DSA Incidence in Lung Transplant Recipients Purpose The SARS-CoV-2 pandemic has brought many challenges into the field of transplantation. The infection itself leads to a broad activation of B-lymphocytes, which in combination with reduced immunosuppression and systemic pro-inflammatory state may possibly lead to an alloimmune response. The main objective of this retrospective single-center study was to evaluate the effect of SARS-CoV-2 infection on anti-HLA antibody dynamics and development of de novo donor specific antibodies (dnDSA) in lung transplant recipients (LTRs). We also aimed to determine the outcomes of treatment with convalescent plasma (CP) and mycophenolate mofetil (MMF) reduction. Methods A cohort of 27 LTRs infected by SARS-CoV-2 was retrospectively analyzed. The median age of LTRs at infection was 45.4 years (IQR 26.8-59.5) and median time between transplantation and infection was 16.8 months (IQR 8.0-56.9). The inclusion criteria were history of SARS-CoV-2 infection and screening for anti-HLA antibodies (Luminex technology, One Lambda) before and after infection (median 84, IQR 29-239 days and median 55, IQR 32-90 days resp.). Results No dnDSA were detected after SARS-CoV-2 infection. De novo class II anti-HLA antibodies with low mean fluorescence intensity (MFI) were observed in 1 patient (3.7%) treated with favipiravir and MMF discontinuation without receiving CP. The standard therapeutic regimen consisted of specific antiviral therapy (remdesivir n=15, 55.6%; favipiravir n=12, 44.4%), reduced or discontinued MMF (n=10, 37.0% and n=17, 63.0%, resp.) and administration of CP (n=18, 66.7%) (Table 1). Conclusion In this retrospective study we did not observe a significant effect of SARS-CoV-2 infection, MMF reduction or CP treatment on anti-HLA antibody dynamics and dnDSA incidence in LTRs. Therefore, CP and MMF withdrawal may be considered as safe therapeutic options regarding antibody-mediated rejection in LTRs affected by SARS-CoV-2. Future studies in larger cohorts are needed to confirm the findings. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3606 | Epidemiologic Analysis of Delta Variant SARS-CoV-2 in a Cohort of Lung Transplant Recipients Purpose Lung transplant (LTx) recipients have increased risk of infection with SARS-CoV-2 and have reduced efficacy from COVID-19 vaccination. The Delta variant of SARS-CoV-2 has increased virulence compared to earlier variants. We hypothesized that LTx recipients would have increased susceptibility to Delta variant infection despite vaccination. Methods We performed a retrospective cohort study of 314 LTx recipients followed between 1/1/2020-9/30/2021. Diagnosis of SARS-CoV-2 infection by PCR was recorded; Delta variant comprised >99% of strains from 6/1/2021-9/30/2021. Data regarding COVID-19 vaccination status, symptom development, hospitalization, intubation, and death were collected. Results Forty-four patients (14%) were diagnosed with COVID-19, 18 (41%) of which were Delta variant. The rate of infection with Delta was 4-fold higher than with earlier strains (Figure, 0.016 vs. 0.004 cases / patient months, p<0.001). Fifteen (83%) patients diagnosed with Delta variant were fully vaccinated at the time of infection (p<0.001). The rate of infection with Delta variant in vaccinated and unvaccinated individuals was similar (0.017/patient months with vaccine, 0.015/patient months without vaccine, p=0.84). The majority (>89%) of patients had respiratory symptoms in both groups. More patients with Delta variant received monoclonal antibody infusions (89% vs. 54%, p=0.021) and fewer patients with Delta variant had resolution of disease (50% vs. 92%, p<0.001). There was a trend towards greater O2 needs with Delta variant (p=0.07). Hospitalization (38% vs. 23%), intubation (11% vs. 4%), and death (11% vs. 4%) were numerically greater with Delta variant, although not statistically significant. Conclusion The incidence rate of SARS-CoV-2 infection was significantly greater with Delta variant in LTx recipients, despite high prevalence of full vaccination during the Delta wave. Further study in larger cohorts is needed to determine whether booster vaccines can reduce such infectivity. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3607 | Effectiveness of Messenger Ribonucleic Acid Vaccine in Lung Transplant Recipients Purpose Immunization is heralded as a key tool to combat the COVID-19 pandemic. One key technology, messenger RNA (mRNA) vaccines have demonstrated an efficacy greater than 94%1,2. While mRNA vaccines create strong protection in the majority of patients, the antibody response in solid organ recipients has been reported to be less reliable3. Herein, we report the incidence and mortality of COVID-19 in lung transplant recipients after receiving a messenger RNA vaccine (BNT162b2 [Pfizer-BioNTech] or mRNA1273 [Moderna]). Methods From February 1, 2021 to September 1, 2021, SARS-CoV-2 positivity, admissions to the hospital, and mortality among lung transplant recipients was recorded at our institution. This timeframe was selected as the mRNA vaccine became available to recipients of lung transplantation in February of 2021. To obtain the immunization status of lung transplant recipients eligible for vaccination with one of the two mRNA vaccines, a query of the electronic medical record was performed during the previously mentioned dates. Results Among 317 patients, 276 had received at least two doses of mRNA vaccine (87%). Twenty-six tested positive (8.2%). Of the 26 individuals who developed COVID-19, 20 (76.9%) required admission to the hospital with eight deaths (30.8%). Four deaths occurred among the 13 individuals who contracted SARS-CoV-2 despite having received a minimum of two doses of mRNA vaccine representing a 30.7% mortality. The average duration between immunization and a positive PCR result was 86 days (SD 56 days) for individuals who had received at least two doses of a vaccine. Conclusion Recent studies have shown that a third dose of the mRNA vaccine BNT162b2 (Pfizer-BioNTech) can augment the antibody response in solid organ transplantation recipients4. The immunogenicity of the mRNA vaccine in this population still remains less vigorous compared to the immunocompetent. The reduced efficacy of mRNA vaccines combined with the elevated rate of admission and mortality described above, demonstrate that vaccination alone cannot annul the impact of COVID-19 in these patients. When mask wearing, social distancing, and hand-washing fail, therapies such as casirivimab and imdevimab (REGN-COV2), neutralizing monoclonal antibodies against SARS-CoV-2 could be considered in early disease to suppress viral load5 and protect this vulnerable population despite immunization status. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3608 | Persistent Subclinical SARS-CoV-2 Isolation After Redo Lung Transplant for COVID-19 induced Lung Injury Introduction Lung transplantation (LTx) is lifesaving for patients with irreversible lung injury due to COVID-19; however, all viable virus must be cleared before transplant. Prolonged viral shedding is common, particularly among immunosuppressed patients. Thus, ongoing detection of SARS-CoV-2 RNA may delay transplant and prolong hospitalization. We report a case of an LTx recipient who developed COVID-19-associated lung injury with prolonged viral shedding that persisted following redo LTx. Case Report A 48-year-old man developed COVID-19 17 months after bilateral LTx. His illness rapidly progressed to hypoxemic respiratory failure requiring bilevel ventilation and prone positioning. He was treated with corticosteroids, remdesevir, convalescent plasma, anticoagulation, and reduced immunosuppression. Tocilizumab was not administered as data supporting its use was unavailable. Despite aggressive therapy, he remained hypoxemic and developed radiographic evidence of pulmonary fibrosis. SARS-CoV-2 was persistently isolated between November 2020 and April 2021; the PCR cycle threshold in March 2021 was 32, indicating a low level of viral RNA. There was no evidence of antibodies to SARS-CoV-2. Finally, after 2 negative nasopharyngeal swabs in April, he underwent redo bilateral LTx in May 2021, 163 days after his initial diagnosis. Postoperative critical illness myopathy required prolonged mechanical ventilation, nutrition via a feeding tube, and 19 days at an acute rehabilitation center. Routine surveillance bronchoscopy 40 days after retransplant revealed SARS-CoV-2 in bronchoalveolar lavage fluid and again in a nasal wash sample. He had no COVID-19 symptoms at the time of viral isolation, and inflammatory markers were normal. He was empirically treated with casirivimab and imdevimab, with resolution of SARS-CoV-2 isolation 8 days later. Summary Prolonged viral shedding is common in immunocompromised patients with COVID-19; however, ongoing viral isolation is not a reliable indicator of active viral replication and transmissibility. Our patient had persistent SARS-CoV-2 isolation after redo LTx with no evidence of COVID-19 or allograft injury. Thus, persistent viral shedding alone may not be an absolute contraindication to LTx and additional factors such as PCR cycle threshold and time from original infection should be considered. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3609 | Short and Intermediate Term Effects of COVID-19 Infection on Lung Transplant Recipients Purpose The characteristics and outcomes, including acute cellular rejection (ACR), of lung transplant recipients (LTR) post COVID-19 infection are incompletely studied. We sought to show whether or not COVID-19 infection in LTR is associated with ACR. Methods This single center, retrospective study of LTR examined data among those who contracted COVID-19 between June 2020 and May 2021. Patient demographics, immunosuppression regimen, and hospital course related to COVID-19 infection were recorded. Subsequent spirometry, imaging, and biopsy results were documented. Results We identified 16 LTR who tested positive for COVID by PCR testing. Acute radiographic changes were detected in half (8) of the cohort, 3 patients eventually required ICU admission, 1 which required venovenous extracorporeal membrane oxygenation. The median drop in FEV1 and FVC after COVID-19 infection was -375 (-1140 to +120) and -260mL (-1790 to +410), respectively. ACR was diagnosed in 2 patients at 6 weeks post COVID-19 infection. Both of the patients who were diagnosed with ACR required hospitalization, and one required ICU admission. There was 1 death at >6 months after infection due to progressive chronic lung allograft dysfunction and renal failure. Conclusion This analysis characterizes short and intermediate term outcomes of LTR after COVID-19 infection. Specifically, the association between such infection and both rates of ACR and allograft function is uniquely described. ACR was observed in 12.5% of patients 6 weeks post COVID-19 infection. There was a notable reduction in lung function, which was mostly accounted for by the 3 patients in our cohort who required ICU admission. This study has several limitations. The sample size is small and involves a single center. It is also retrospective in nature, and there were a large number of asymptomatic patients included. Further analyses, to further assess the incidence of ACR in LTR are warranted to determine the associated factors and optimize management in this at risk patient population. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3610 | Characteristics and Outcomes of Recipients of Heart Transplant with Coronarvirus Disease 2019 Who Received Casirivimab Plus Imdevimab Infusion Purpose Heart transplant (HT) recipient are at increased risk of adverse outcomes following COVID-19 infection and may benefit from monoclonal antibody infusion to mitigate progression to clinically severe disease. The aim of this study is to describe the outcomes of HT patients who experienced mild to moderate coronavirus disease 2019 (COVID-19), with subsequent administration of casirivimab plus imdevimab administration. Methods A retrospective review of all HT recipients who were infected with COVID-19, and subsequently infused with monoclonal antibodies in a large academic medical center between January 1, 2021 to September 1, 2021. Results 14 HT patients were included in the analysis. The median age was 57.5 (interquartile range [IQR], 41.5-64) years, 10 (71%) were men, and median time from HT was 3.48 (IQR, 1.00-11.82) years. Comorbid conditions included hypertension in 6 patients (43%), diabetes in 4 (29%), and chronic kidney disease in 6 (43%). Eight patients (57%) were previously vaccinated, predominantly with the Pfizer-BioNTech vaccine. Three participants (21%) were admitted after clinical progression of COVID-19. Among patients managed at the study institution, mycophenolate mofetil was discontinued in two patients (14%) and calcineurin inhibitor was maintained at previous levels in all fourteen patients (100%). Of the admitted patients, 1 was treated with high dose corticosteroids alone and 2 were treated with corticosteroids plus remdesivir. No patient required intubation. All 3 patients were discharged home and no patients in this cohort died. Conclusion In this single-center case series, HT patients with mild-moderate COVID-19 who were treated with monoclonal antibody infusion had a hospitalization rate of 21% and 100% survival. Further studies are required to optimize management of COVID-19 infection in the HT population. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3611 | COVID-19 in Lung Transplant Recipients: Outcomes and Long-Term Follow Up Purpose The COVID-19 pandemic represents a major global health burden, and an important cause of morbidity and mortality nowadays. Data remains scarce on COVID-19 in lung transplant recipients (LTR). The purpose of this study was to understand impact of infection with COVID-19 in this population, to investigate different variables that contributed to the prognosis, and to assess the long-term clinical outcomes. This represents the largest cohort of continuously followed LTR with COVID-19 to date. Methods We conducted an observational retrospective cohort study of LTRs infected with COVID 19 at a major transplant center between June 2020 and April 2021. Infection was defined by having a positive diagnostic polymerase chain reaction (PCR) test. Patients’ characteristics, COVID severity and management were retrieved. Changes in individual patient's FEV1, imaging and trans-bronchial lung biopsies (TBLB) performed at 3, 6, and 12 month intervals after infection were compared to the baseline prior to infection. Results Fifty-three LTRs were identified as having COVID infection. Median age was 64 years, 31 (58.5%) were males, and 48 (90.5%) were double-LTR. Average BMI was 26.71 and 9 patients had diabetes. 38 (71.7%) patients were on three immunosuppression agents, and 4 (7.5%) patients had an augmented immunosuppression prior to COVID infection. 7 (13.2%) patients had at least one dose of mRNA COVID vaccine. 29 (54.7%) patients were treated as outpatient. Among admitted patients, 13 (24.5%) were treated in the ICU, and 7 (13.2%) required mechanical ventilation. Mortality rate was 15.1%. 26 patients had follow up on their FEV1 in 3 months, 33 in 6 months, and 7 up to 12 months. 14 (26.4%) patients had at least >10% drop in their FEV1, of which 10 patients had >20% drop. 18 patients had TBLB in 3 months, 19 in 6 months, and 4 in 12 months. Overall, 7 (13.2%) patients had acute cellular rejections (ACR). 23 patients had chest imaging at time of infection, with CT scan available for 10. Out of these, 6 showed pure ground glass opacities (GGO), and 4 showed mixed GGO and nodular opacities. Conclusion Out of our 53 LTR with COVID infection, 24.5% had severe disease. Mortality was high in our cohort at 15.1%. PFT decline was common, with 26.4% having an FEV1 drop of over 10% at follow up, suggesting persistent complications are common. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3612 | Worsening Mental Health in Adolescent Heart Failure and Transplant Patients During the COVID-19 Pandemic Purpose Center for Disease Control data shows a significant increase in percentage of adults with symptoms of anxiety or depressive disorder during the COVID-19 pandemic. Adolescent heart failure (HF) and heart transplant (HT) recipients report higher prevalence of mood symptoms compared to general adolescent population. The effects of the COVID-19 pandemic on mental health outcomes in Adolescent HF and HT recipients remains unknown. Methods Electronic Mental Health Screens, Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder-7 (GAD-7), were administered at quarterly intervals to patients aged 11 years and older presenting for ambulatory HF and HT care at our center. Screening results from August 2020- February 2021 (COVID Screen) were compared to results from August 2019- March 2020 (Pre-COVID Screen). When multiple Pre-COVID screens were available, the one closest to pandemic start date (April 2020) was used and in case of multiple COVID screens, the one completed during the peak of COVID wave (November-January 2021) was used. Results Demographic data for 37 patients with paired screens is summarized in Table 1. There was a significant increase in mean GAD-7 score, 2.51 (±2.98) Pre-COVID to 3.76 (±4.99) during COVID (p=0.04) and no significant change in mean PHQ-9 score, 2.73 (±3.71) Pre-COVID to 4.05 (±4.83) during COVID (p=0.06). Although there was no significant difference in Pre-COVID screen scores by age or race, the COVID Screen scores were significantly higher for younger adolescents and Black patients for both PHQ-9 and GAD-7 (Table 1). Nine patients (24.3%) were receiving treatment for mood disorders pre-COVID and 11 (29.7%) during COVID (p=0.50). Conclusion Adolescents with HF and HT reported worsening anxiety symptoms during COVID similar to the worsening mental health trends for young adults noted nationwide. Younger and Black adolescents with HF or HT reported worse anxiety and depression symptoms during the pandemic compared to other demographics. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3613 | Bivalirudin Anticoagulation in ECMO (ECMO) for Severe Coronaviral Disease Related Acute Respiratory Distress Syndrome (ARDS) Purpose ECMO as a bridge, is a potential option in patients with severe COVID-19 who develop respiratory failure despite maximal conventional therapy. Heparin has been the standard anticoagulant, but is associated with bleeding and thrombocytopenia. Bivalirudin has been successfully used as an alternative in cases of heparin induced thrombocytopenia (HIT). We evaluated Bivalirudin as an anticoagulant in COVID-19 patients on ECMO who develop HIT or had persistent thrombocytopenia despite multiple platelet transfusions. Methods After institutional clearance, we performed retrospective analysis of all the COVID-19 related ECMO managed in our centre between January to August 2021. Femoral vein to internal jugular vein ECMO was instituted in all these patients and anticoagulation targets were monitored daily as per institutional protocols. We compared incidence of ECMO circuit and oxygenator changes, post procedural bleeding and the number of blood products transfused between the Heparin and Bivalirudin group. Descriptive analysis was carried out by mean and standard deviation. The mean values were compared using student t-test and categorical outcomes using Chi square test. Results Total of 42 COVID-19 ARDS related ECMO were managed in our centre during the study period. 8 patients were switched to Bivalirudin, as 2 patients were diagnosed with HIT and 6 had persistent thrombocytopenia despite multiple platelet transfusions. In patients with HIT, the platelet count improved by 72 hours. The incidence of post tracheostomy and intercostal drain insertion bleed was statistically higher in Heparin group (p <0.05). Total number of packed cell transfusion was significantly less in Bivalirudin group but platelet transfusion was lower, though not statistically significant. The usage of fresh frozen plasma and cryoprecipitate were similar. The rates of ECMO oxygenator and circuit exchanges were comparable with mean duration of 13.5 days for change from the date of initiation. Conclusion Bivalirudin is a feasible alternative anticoagulant in the COVID-19 ECMO with the benefit of lower rates of bleeding and consequent need for transfusion. Further large studies are needed to assess the efficacy and benefits of direct thrombin inhibitors as a practical and safe substitute to Heparin in these situations. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3614 | SARS-CoV-2 Vaccination Efficacy & Safety in Lung Transplantation Recipients: A Single Centre Study Purpose Solid Organ Transplant recipients (SOT) are at higher risk of SARS-CoV-2 infection. Mortality rates reported between 13 to over 30% in SOT recipients. SARS‐CoV‐2 vaccination may help reduce the morbidity and mortality of COVID‐19 among SOT. There is paucity of literature of SARS-CoV-2 vaccination efficacy in lung transplantation recipients . The purpose of the study was 1) to evaluate SARS-CoV-2 vaccination efficacy & safety in lung transplantation recipients and 2) to assess the need for 3rd booster dose. Methods A retrospective study (from Jan 2021 till Oct 2021) of lung transplantation recipients receiving 2 doses of SARS-CoV-2 vaccination available in India i.e. ChAdOx1 nCoV- 19 Corona Virus Vaccine (Recombinant) or Whole-Virion Inactivated Vero Cell vaccine, was done to evaluate vaccination efficacy and safety. SARS-CoV-2 spike COVID antibodies levels were checked 4 weeks after 2nd dose of vaccination. Local and Systemic reactions to vaccination were noted Results 11 Bilateral lung transplantation recipients and 4 Combined Heart-Lung transplantation recipients received SARS-CoV-2 vaccination. Out of 15 recipients, 11 recipients received ChAdOx1 nCoV- 19 Corona Virus Vaccine (Recombinant) and 4 recipients received Whole-Virion Inactivated Vero Cell vaccine. 12 recipients developed mild pain at vaccination site, 2 recipients developed local tenderness and 1 recipient developed redness at vaccination site as part of local reaction . 5 recipients developed fever, 5 recipients experienced fatigue/bodypain, 2 recipients had vomiting, 2 recipients experienced headache & 1 recipient developed abdominal pain as part of systemic reactions. 8 (53.3%) out of 15 recipients developed significant SARS-CoV-2 spike antibodies level demonstrating vaccination efficacy. 7 (46.6%) recipients demonstrated lower SARS-CoV-2 antibodies titre (Less than cut off values) indicating no significant vaccination efficacy. 1 recipient developed vaccine breakthrough mild infection after 2nd dose. Conclusion Our experience has shown that SARS-CoV-2 vaccination efficacy was demonstrated in nearly 50 % of lung transplantation recipients. The study also showed safety of SARS-CoV-2 vaccines in such immunocompromised subset. However, for those recipients with no vaccination efficacy, utility of 3rd booster dose and at what interval needs more research. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3615 | Short Term Outcomes of Patients Who Underwent Lung Transplant for COVID-19 ARDS Purpose Lung transplantation is a life saving treatment option for patients with COVID-19 ARDS. We aim to assess the short-term outcomes of patients who underwent lung transplantation for COVID ARDS. Methods This is a single-center retrospective cohort study of patients who underwent lung transplantation for COVID 19 ARDS between 7/1/2020 and 06/30/2021. Study was IRB-approved. Baseline demographic data, pre transplant variables, peri operative data and post transplant variables were extracted. Post-transplant graft function variables were followed until 09/30/2021. Results Twenty patients underwent lung transplantation alone, and one patient underwent lung kidney transplantation. Nineteen patients (90%) were ECMO bridge to transplant and twenty patients (95%) were on mechanical ventilator until the transplant. These patients were followed for a median of 234 days [IQR (188-339)]. Three patients (14%) completed a one-year follow-up. Eighteen patients (86%) completed six months follow-up. None of the patients required dialysis. At the end of the follow up period, all patients have good graft function and none of the patients are on supplemental oxygen. Conclusion With careful selection, lung transplants can be performed with reasonable post-transplant outcomes in COVID 19 ARDS patients. However, these patients tend to have a prolonged post transplant hospital stay, a median of 48 days with IQR (28.5 - 73.5). 50% of patients had at least one return to operating room post transplant for hemothorax. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3616 | Safety, Reactogenicity and Patient Perceptions of COVID-19 Vaccination in Solid Organ Transplant Recipients at a Quaternary Referral Center Purpose Solid organ transplant recipients (SOTR) are at high-risk for poor health outcomes following COVID-19. Several studies have evaluated the antibody response to the vaccine amongst SOTR, yet there is a need to better understand peri-vaccination reactogenicity and patient behavior in SOTR. Our study reports the side effects, safety and the patient perceptions of the Pfizer vaccine amongst our center's SOTR. Methods In this single-center study, SOTR (heart, kidney, liver, lung, combined) who received the Pfizer (BNT162b2) vaccine in February-March 2021 completed an online survey about their side effects (SE) after the first and second dose of the vaccine, co-morbidities, masking behaviors, breakthrough infection, and perceptions regarding sense of protection and safety after vaccination. Descriptive and logistical regression analyses were performed. Results The survey was sent to 550 SOTR, of which 210 SOTR completed it thus far. Median age is 62 years, 154 (72%) are males and 61 (28 %) are females. 81 (39%) experienced SE after both doses. After dose one, 53% patients experienced a SE, the most common being injection site pain (79%). After dose two, 53% patients experienced a SE, including injection site pain (61%) followed by systemic SE (39%). No patient hospitalization after either dose was reported. Within a 6-month period post vaccination, only 1 patient tested positive for COVID-19 after the first dose. Increased age reduced the risk for SE for both first and second doses (0.95 (0.92-0.97, p<0.001 and 0.96 (0.94-0.99), p<0.002). SOTR without diabetes had a significant increase in injection site pain (1.92 (1.05-3.49),p=0.033). For masking behaviors, 83% plan to continue masking in healthcare settings while 10% will no longer mask in any setting. Regarding sense of worry of receiving the vaccine, 66% did not feel worried while 10% felt very worried. After vaccination, 53% felt very protected while 15% did not feel protected at all. Conclusion In SOTR who received the Pfizer vaccine, 39% of patients reported side effects after both doses. Injection site pain was most common after first dose and systemic side effects were more after the second dose. The study reinforces the safety profile of the vaccine and SOTR with reactogenicity similar to other studies. Even after vaccination, majority of SOTR plan to wear masks in various settings. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3617 | Outcomes in Post Lung Transplant Patients Diagnosed with COVID-19 Purpose The manifestations and complications of SARS-CoV-2 infection in solid organ transplant are poorly known. Lung Transplant group is an immunocompromised group with a shock organ of COVID-19. For this, we analyze the possible risk factors associated with an unfavorable outcome Methods Retrospective study between the period march 2020 until june 2021. We analysed the database of Lung Transplant and medical records. It included all patients with a confirmed diagnosis of COVID-19 in our cohort with RT-PCR SARS-COV-2 or rapid test and chest computed tomography compatible. We analyzed demographic features and outcomes: sex; type of transplant (unilateral or bilateral); presence of chronic graft dysfunction; transplant time; confirmed prior rejections; history of SAH and/or DM; nosocomial transmission infection; report of fever and/or dyspnea; need for hospitalization and/or ICU; use of an O2 nasal catheter and/or mechanical ventilation; need of dyalisis; associated bronchopneumonia (confirmed by culture); and previous use of 2 or more immunosuppressants. Statistical analysis was performed and multivariate analysis Results In our cohort, we had 213 patients in follow-up (March 2020) and during this period 29 (13.6%) patients with COVID-19 were evaluated. These 23 with diagnosis and supervised treatment in our service and 6 patients in external follow-up of the infectious condition. Overall death was 31% (9).The mean age of patients is 46 years (±15.66), being 51.8% male and 48.2% female. A multivariate analysis, only dialysis (HR 9.186 - CI 1.804-46.758 - p=0.008) and bronchopneumonia (HR 7.554 - CI 1.510-37.790 - p=0.014) are associated with a negative outcome. Conclusion The lethality is high in this group of patients. Our data was shown that dialysis and bronchopneumonia are associated with a higher risk of death in this group of patients infected with COVID-19. We emphasize that the limitation of this work is mainly due to the small sample analyzed. We suggest more studies are necessary. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3618 | Use of REGEN-COV in Pediatric Patients After Heart Transplantation for Treatment and Post-Exposure Prophylaxis of COVID-19 Purpose Pediatric heart transplant (HT) patients are vulnerable to severe COVID-19 disease. REGEN-COV is a recombinant human monoclonal antibody to the spike protein of SARS-CoV-2; comprising of Casirivimab and Indevimab. It recently received emergency use authorization by the U.S. FDA for use as post-exposure prophylaxis (PEP) for COVID-19 in adult and pediatric patients (≥12 years and ≥40 kg) at high risk for progression to severe COVID-19. It is also authorized for the treatment of mild-to-moderate COVID-19 with positive RT-PCR, in patients at high risk for progression to severe COVID-19. We sought to review our experience in use of REGEN-COV in pediatric HT patients. Methods A retrospective chart review was performed to identify patients who received REGEN-COV for PEP or to prevent progression to severe COVID-19. Detailed demographic and clinical data was collected. Results Six pediatric patients received REGEN-COV, 4 received after a positive RT-PCR and 2 received as PEP with a negative RT-PCR. Median age was 16.5 years (range: 15-19) and median time from transplant was 29 months (range: 2-140). There were equal number of males and females. Of those positive for COVID-19, 3 demonstrated mild symptoms (2 respiratory and 1 gastrointestinal) and 1 was asymptomatic. Both patients who received PEP were asymptomatic however were <1 year from transplant. All patients received REGEN-COV within 5 days of testing positive or exposure. Patients who received it for PEP continued to remain RT-PCR negative. None of the patients demonstrated changes on their echocardiogram after the infection and tolerated the infusion without any complications. Further details of immunosuppression, panel reactive antibodies and comorbidities are presented in Table 1. None of the patients required any modifications in their immunosuppression. Conclusion REGEN-COV was tolerated without any complications in pediatric heart transplant patients and no modifications in immunosuppression were required. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3619 | Immunologic Monitoring of a Breakthrough Infection in a Heart and Kidney Transplant Recipient Introduction Solid organ transplant recipients (SOTR) have lower SARS-CoV-2 spike seroconversion than healthy subjects (HS) following vaccination. A breakthrough (BT) infection is defined as the detection of SARS-CoV-2 in a respiratory specimen after a person is ≥14 days after completing the recommended doses for a vaccine. We report a case of SARS-CoV-2 BT infection in a SOTR who was immunologically followed longitudinally following vaccination. Case Report A 44-year-old man with a history of non-ischemic cardiomyopathy (NICM) and end stage renal disease had undergone heart and kidney transplantation in December 2017 with thymoglobulin induction. His NICM was secondary to radiation for non-Hodgkin's lymphoma treated with autologous bone marrow transplant in 2001. Maintenance immunosuppression consisted of sirolimus 2mg daily, tacrolimus 2mg twice daily (BID), and prednisone 5mg daily at his 1st Moderna vaccine in April 2021. In anticipation of surgery, sirolimus was stopped and mycophenolate mofetil (MMF) 500mg BID was started. He was on this regimen at the time of his 2nd Moderna vaccine. Sirolimus was restarted in July and increased to 1mg daily while continuing MMF 500mg BID, tacrolimus, and prednisone. At the end of July, the patient was exposed to several family members with COVID-19. He tested positive 89 days after his 2nd Moderna vaccine (cycle threshold of 33.5). He was asymptomatic at the time, but later developed fever, myalgias, headache, and loss of taste and smell and was treated with casirivimab and imdevimab monoclonal antibody (mAb) infusion. We assessed the patient's immunologic response 14 days post 2nd Moderna vaccination and at BT infection prior to mAb infusion and compared this to HS. The patient developed SARS-CoV-2 spike-specific CD4+ T cells at 14 days post 2nd mRNA vaccine at a frequency below the average frequency for HS. At BT infection, the patient did not have SARS-CoV-2 spike-specific CD4+ T cells, partly due to virus induced lymphopenia. The patient did not develop spike-specific CD8+ T cells, spike IgG or neutralizing antibodies at 14 days post 2nd Moderna vaccination or at BT infection. Summary The patient developed SARS-CoV-2-specific CD4+ T cells following vaccination. His uneventful recovery may be secondary to these SARS-CoV-2 specific CD4+ T cells post vaccination as well as receiving mAb therapy 8 days post infection. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3620 | Is There Heterogeneity on Outcome of Hospitalized Heart Transplant Patients with COVID-19 Infection Across the US? Purpose The COVID-19 pandemic infected large portions of the US community and infected many heart transplant (HTx) patients but in distinct geographical patterns. HTx programs have reported mortality in the range of 23-29% (East Coast of the US) and in non-transplant patients in the range of 15-17%. The impact of hospitalized HTx patients with COVID-19 infection in a large West Coast heart transplant program has not been reported. We now report our outcomes for hospitalized patients with COVID-19. Methods Between March 2020 and March 2021, we assessed 22 HTx patients who were admitted to the Cedars-Sinai Medical Center (CSMC) for COVID-19 infections. COVID-19 is known to affect many systems within the body, and we report the effects on lungs, heart, and kidney. Morbidity and mortality, including risk of death, were included within 90 days post-infection. Results Of the 22 HTx patients hospitalized at the CSMC, 7 patients died (31.8%). All patients had COVID-19 pneumonia requiring supplemental oxygen and 5 patients required ventilatory support. The mean peak FiO2 of the patients was 79.7%. 16 of these patients also were noted to have an increase in serum creatinine, with 6 patients requiring kidney dialysis. Cardiac function was maintained in all patients with COVID-19 and no myocarditis or cardiac dysfunction was observed. 9 patients received remdesivir and 19 patients received corticosteroids. 4 patients received tocilizumab anti-inflammatory therapy. Conclusion COVID-19 resulted in significant morbidity and mortality in hospitalized heart transplant patients. Outcomes on the West Coast of the US were similar to the East Coast. The immunosuppressed state appears to be a risk factor for poor outcome and is higher compared to non-transplant hospitalized patients. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3621 | Alloimmune Response After SARS-CoV-2 Vaccination in Lung Transplant Purpose The effect of SARS-CoV-2 vaccination on de novo donor specific antibodies (dnDSA) in lung transplant recipients (LTRs) is unknown. We reviewed dnDSA results following SARS-CoV-2 vaccination in LTRs based on SARS-CoV-2 IgG response. Methods LTRs were tested for SARS-COV-2 Multi-target IgG at 3 and 6 months post-vaccination. LTRs who received at least 1 dose of SARS-CoV-2 vaccine between 12/01/2020 to 07/01/2021 were included in this retrospective review. We compared patients based on anti-spike (S-IgG) results. Results We reviewed 55 LTR charts with S-IgG results. Only 24 (44%) developed S-IgG by 6 months after vaccination. Differences between S-IgG positive and negative groups are shown in the table. Those with positive S-IgG were further from transplant, had lower mycophenolate doses, more likely to have had COVID infection pre-vaccination, and had lower rates of hypogammaglobulinemia. Only 3 patients (5.5%) developed dnDSA after vaccination; all were S-IgG positive. One had history of antibody mediated rejection (AMR), while another was initially negative for dnDSA at 6 weeks post-vaccination, but turned positive at 7 months (low level Class II DSA). One patient who had prior DSA developed clinical rejection (AMR) with Class II dnDSA (DR7) and significant rise in prior DSA (DR53, DQ2) to >20,000 MFI at 6 months (negative at 3 months) post-vaccine in the setting of new viral infection. Another patient was excluded from this study as he died of AMR and dnClass II DSA (DQ8 > 10,000 MFI, DQ6, DR4 within 5 days of dose) 2 months after his first Pfizer/BioNTech dose, but before 3 month S-IgG testing. Conclusion In our cohort, dnDSA after SARS-CoV-2 vaccination was uncommon but observed in patients who developed S-IgG response. The single AMR case occurred late and may be related to infection. In the excluded patient with acute AMR early after vaccine, correlation to S-IgG is unknown as the patient did not survive to 3 months. Further studies are needed to determine the impact of additional vaccine doses and long-term outcomes and immune responses. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3622 | Changes in Therapy Outcome of Veno-Venous ECMO for Therapy-Refractory COVID-19 Infections Throughout the Pandemic Purpose Since the beginning of the current pandemic in late 2019, three accumulations of severe COVID-19 infections (so-called infective waves) caused a fulminant increase in hospitalization. In therapy-refractory patients, veno-venous extracorporeal membrane oxygenation (vv-ECMO) was used since the early beginning. However, potential developments in vv-EMCO therapy still need to be proven. Methods Between 2020 and 2021 a total of n=60 patients were treated with vv-ECMO for severe COVID-19 related acute respiratory distress syndrome in our department. The patients were prospectively enrolled into an institutional database, followed-up and subsequent retrospectively reviewed. Patients were divided concerning the date of vv-ECMO onset into three groups (03/2020-09/2020: 1. wave, n=11; 10/2020-02/2021: 2. wave, n=23; 03/2021-08/2021: 3. wave, n=26). Results From the first to the third wave, patients seemed to be younger, more likely to be female as well as more likely obese. While patients of the first wave regularly developed acute kidney failure (81.3 %), these adverse event was seldom in the second (21.7) and third wave (15.4 5)(p=0.01). In contrast to that, other device-related complications such as stroke, bleeding or visceral ischemia did not differ between the three waves. Most apparent changes during the pandemic were prolonged ECMO support duration (1. wave: 8.5 ± 2.1, 2. wave: 54.0 ± 122.7, 3. wave: 28.0 ± 18.6), ECMO weaning rate (1. wave: 18.2 %, 2. wave: 39.1, 3. wave: 44.0 %) and in-hospital mortality (1. wave: 81.8 %, 2. wave: 69.6, 3. wave: 56.0 %), although none of these effects reached statistical significance. Conclusion Although our data cover only a small study population, we observed clear trends towards younger and heavier patients during the pandemic. Most likely, due to a learning effect, support duration of ECMO patients distinctly increased during the pandemic. Subsequently, weaning and survival also increased. However, differences in patient selection could act as a major confounder for these results. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3623 | Mesenchymal Stem Cell Therapy for Patients with Post COVID ARDS on ECMO Referred for Lung Transplantation-Single Center Experience from India Purpose India experienced a devastating second wave of the covid 19 pandemic triggered by the delta variant, which peaked in end of April and early May 2021 with average daily new cases hitting 300,000 to 400,000 and daily death toll reaching 3000 to 3500. ECMO emerged as an option for severe post covid ARDS and was offered in many centers across India for patients who were worsening despite full ventilatory support and prone positioning. A small minority of these patients who showed no improvement despite several weeks on ECMO were referred for lung transplantation to our center. Out of the 63 ECMO pts we received for Lung Transplantation 5 patients received Mesenchymal Stem Cell (MSC) infusion over and above standard treatment after getting necessary clearance from hospital Ethics committee and consent from patients’ family Methods We conducted a case control study on critically ill post covid ARDS patients on ECMO referred for lung transplantation to our center. 5 patients received 2 million umbilical cord derived MSCs/kgwt infused over 30 minutes, for 3 doses on days 0, 3 and 6 and was compared to other local ECMO patients (control group; n=58). The primary outcome was safety and secondary outcome was all cause mortality. Results All 5 patients tolerated MSC infusions well with no side effects observed. Out of the 5 patients who received MSC infusions 3 pts (60%) recovered and were weaned off ECMO successfully. 1 pt (20%) did not improve and expired, 1 pt (20%) did not recover and underwent successful lung transplantation and was discharged home. In the ECMO control group, 15 patients (26%) recovered without transplant, 23 pts (40%) underwent successful lung transplantation and 20 pts (34%) expired. Conclusion MSC IV infusion is safe and well tolerated without side effects in covid ARDS pts on ECMO. The efficacy of MSC in repairing the covid destroyed lung should be further evaluated in large randomised controlled studies. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3624 | COVID-19 in Lung Transplanted Patients: Chronicles from an Italian Epicenter Purpose Lombardy was one of the hardest hit regions in Italy during the COVID19 pandemic. We hereby report our experience with SARS-CoV2 infection in lung transplant recipients. Methods We retrospectively collected clinical data on all the consecutive cases of COVID19 in our centre, based in Milan, from March 2020 to August 2021. Diagnosis was always confirmed by a positive nucleic acid amplification test (RT-PCR) for SARS-CoV-2 on nasopharyngeal swab and/or tracheal aspirate. Results 21 patients were diagnosed with COVID19. Figure 1 summarizes the clinical course of these individuals. We reduced immunosuppressive regimen in all these patients, typically holding the antiproliferative agent and augmenting steroids; when hospitalized, everybody received initial empiric antibiotic treatment with piperacillin/tazobactam and high-dose LMWH. Hydroxychloroquine was used only in the first wave (4 patients). One patient was compassionately administered anakinra and remdesivir as a “rescue therapy”. Lymphocitopenia was a common presenting sign (14 patients, 66%). Aspergillus co-infection occurred in 5 patients (24%). Mortality rate was 29%; 4 out of these 6 patients were affected by CLAD and 3 had chronic kidney disease. Of note, in March 2021, we tested all our patients for anti-SARS-CoV-2 nucleocapsid antibodies before starting vaccinations: we found three additional seropositive patients, who were not included in the present analysis, but had been presumably affected by an asymptomatic/mild form of the disease. Conclusion Apart from immunosuppression, the majority of our patients presented at least one risk factor for mortality in COVID-19 (diabetes, chronic kidney disease, arterial hypertension) and, for this reason, we felt that they should be hospitalized to enable close monitoring and prompt management of possible complications and deterioration. Clinical course seemed favorable in only two thirds of our patients but, for the time being, none of these individuals showed sign of new-onset CLAD after COVID19. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3625 | Long-Term Outcomes Following Double Lung Transplantation for Severe COVID-19 Infection Purpose : Lung transplantation is a potentially lifesaving treatment for severe COVID-19 acute respiratory distress syndrome (ARDS), when optimized medical treatment fails to accomplish lung recovery. However, since the long-term outcomes remain unknown, concerns related to the use of lung transplantation in critically ill COVID-19 patients persist. In the current study, we evaluated consecutive patients that underwent lung transplantation for severe COVID-19 ARDS at our center and compared their post-transplant outcomes with those undergoing transplantation for non-COVID-19 pathology during the concurrent study period. Methods All consecutive patients undergoing lung transplantation between January 2020 to May 2021 were included. The study included two cohorts of patients that underwent transplantation for non-COVID-19 disease (nC19) or refractory COVID-19 ARDS (C19). For additional analysis, we included consecutive patients with severe COVID-19 that required veno-venous extracorporeal membrane oxygenation (ECMO). Results We found that post-procedure complications and length of stay were significantly greater compared to transplants performed for non-COVID-19 lung diseases during the concurrent study period. Following transplant the COVID-19 cohort demonstrated a more rapid improvement in Karnofsky performance status. At one year, all recipients in COVID-19 cohort were alive with post-transplant survival no different than institutional non-COVID-19 recipients. Furthermore, when compared to propensity-matched recipients from SRTR, post-transplant survival of institutional COVID-19 ARDS patients was non-inferior. There was progressive reduction in the probability of separation from extracorporeal membrane oxygenation (ECMO) with time and ECMO support greater than 30 days was associated with a significantly greater risk of death in patients with COVID-19 ARDS. In those who remained unweanable from ECMO after 30 days, lung transplant was an independent predictor of survival. Conclusion We conclude that lung transplantation in selected patients with severe COVID-19 ARDS who remain unweanable from extracorporeal life support can result in post-transplant outcomes comparable to recipients with chronic end-stage lung diseases and non-COVID-19 ARDS. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3626 | Secondary Bacterial and Fungal Pneumonia Complicating SARS-CoV-2 and Influenza Infections in Lung Transplant Recipients Purpose Select bacterial and mold infections are known risk factors for chronic allograft dysfunction (CLAD) in a subset of lung transplant recipients (LTR). Secondary bacterial (SBI) and fungal infections (SFI) have been described among people with severe influenza infection and COVID-19 requiring mechanical ventilation, but the incidence and clinical outcomes of LTR who develop secondary infections following respiratory viral infections (RVI) are not well described. Methods We conducted a retrospective study of LTR who were diagnosed with either influenza or COVID-19 from January 2011-May 2021. Infection definitions and CLAD stage were defined according the International Society of Heart and Lung Transplantation guidelines. Results Fifty-seven LTR with influenza and 33 with COVID-19 were identified. Eleven (19%) of the LTR with influenza developed SBI and seven (21%) with COVID-19 developed SBI (p=0.83). Among patients who developed SBI, Pseudomonas aeruginosa was the most common isolated pathogen (44%). Five (9%) and 7 (21%) LTR developed SFI within 90 days post Influenza and COVID-19 infection, respectively (p = 0.09). Among patients with fungal infection, Aspergillus species were the most common pathogen (75%). At 180 days post RVI, all-cause mortality was higher in LTR with SBI (17%) compared to those without (3%), p=0.02. Mortality was similarly higher in LTR with SFI (33%), compared to those without (1.3%), p<0.0001. At 180 days post RVI, LTR with SBI had progression of CLAD stage 43% vs 11%, p=0.004. Based on univariable logistic regression, LTR who had augmented corticosteroids at time of RVI, and lower respiratory tract infection (LRTI) had higher risk of SFI (odds ratio (OR) of 6.57 (1.8, 23.9), p=0.002 and 12.5 (2.53, 61.7), p=0.004, respectively). There were trends of increased OR of SBI among LTR with LRTI and LTR requiring ICU admission due to RVI with the ORs of 2.78 (0.98, 8.01), p=0.06 and 3.77 (0.90, 15.84), p=0.07, respectively. Conclusion Secondary bacterial and fungal infections are associated with increased all-cause mortality in LTR with influenza and COVID-19, and in the case of SBI, also associated with CLAD stage progression. LTR with LRTI and augmented steroids may be at increased risk of secondary fungal infections. Strategies to mitigate and improve diagnosis may warrant further examination. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3627 | Post Lung Transplant Rehabilitation Program During the COVID Era Purpose The post lung transplant (LTx) rehabilitation program was required to rapidly reduce service provision during coronavirus (COVID 19) pandemic. This was achieved by minimising the group format, number of sessions and type of exercises performed, as it transitioned from a centre-based supervised program to a home based program. Aim: This retrospective study aimed to compare standardised outcome measures for LTx recipients from the non- COVID era (2019) to those from LTx recipients who completed rehabilitation at home during the COVID (2020). Study population included post LTx males & females > 18 years who underwent BSLTx or SLTx at The Alfred from March to August 2020, compared to a matched cohort transplanted between March-August in 2019. Methods The 2019 post LTx rehabilitation program was a thrice weekly, 8 weekly supervised, group format consisting of 30 minutes cardiovascular training on treadmill and exercise bike plus resistance training for upper and lower limbs. During 2020 (COVID) the rehabilitation program was shortened to a twice weekly, individual, 2 - 3 week format followed by a home exercise program (HEP) using exercise diary and weekly phone follow up. COVID era patients were discharged from the gym to the HEP as soon as they were safe to exercise independently. Outcome measures -six minute walk test (6MWT), grip strength (GS) on a dynamometer and a sit to stand test in one minute (STS) were taken on entry to the rehabilitation program and three months post (3/12P). Quality of life (QOL) questionnaire was completed. Results Groups were well matched for LTx age, surgery and length of hospital stay. After 3 months, COVID era participants had not significantly increased 6MWD compared to Non -COVID era (-183m (-230 to -137)) STS improved significantly in both Non-COVID (p=0.001) and COVID (p=0.008) . There was no improvement in QOL or GS for COVID group, but significant improvements for non-COVID QOL (p=0.001) and GS (p=0.05). Conclusion The change to a HEP in COVID era may have negatively impacted the improvement in functional exercise capacity, GS and QOL for those LTx recipients. Further research is required to develop an optimal HEP model. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3628 | Delayed Neutropenia in Heart Transplant Recipients Following COVID-19 Diagnosis Introduction `Neutropenia is observed after heart transplantation due to medication effects and viral infections. SARS-CoV-2 infection, which causes Covid-19 illness, can uncommonly cause neutropenia in non-transplant recipients. Delayed neutropenia following SARS-CoV-2 infection in heart transplant recipients (HTRs) has not been described. Case Report Case 1: A 45 year old male combined heart and liver transplant recipient was diagnosed with Covid-19 17 months after transplant. Neutropenia had been noted six months after transplant in the setting of valganciclovir and mycophenolate mofetil (MMF) use, which resolved with discontinuation of those medications. At the time of his Covid-19 diagnosis, his immunosuppression regimen included tacrolimus with a target level 8-10 ng/mL and prednisone 5 mg once daily, and he had an asymptomatic course. His absolute neutrophil count (ANC) four weeks prior to Covid-19 diagnosis was 1,690/uL. The ANC obtained nine weeks after Covid-19 diagnosis was 890/uL. Testing for cytomegalovirus was negative and no neutrophil-depleting medications were identified. He received two doses of granulocyte colony stimulating factor (G-CSF). The subsequent ANC two days after the second dose was 3,600/uL. Case 2: A 66 year old male HTR was diagnosed with Covid-19 31 months after transplant. His symptoms included fever, cough, and diarrhea and he was admitted for inpatient care. Immunosuppression at the time of diagnosis included tacrolimus with a target level of 8-10 ng/mL and MMF 1000 mg twice daily, which was later decreased to 500 mg twice daily. The ANC nadir during his acute illness was 1310/uL. Six weeks after Covid-19 diagnosis, his ANC was 420/uL. Testing for cytomegalovirus was negative. The patient required a total of six doses of G-CSF over six weeks due to persistent neutropenia. MMF was discontinued. He was referred to a hematologist for persistent neutropenia. A bone marrow biopsy showed normal neutrophil production, and increased peripheral neutrophil consumption was hypothesized. Summary Acute viral infections including SARS-CoV-2 can cause neutropenia, but delayed neutropenia is rare and has not been described in HTRs. Careful monitoring of the complete blood count (with differential) may be useful in this population following a Covid-19 diagnosis. Modulation of immunosuppression and G-CSF administration can support neutrophil recovery. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3629 | Google Trend's Perspective: Lung Transplant Following COVID-19 Purpose Lung transplant is considered a last resource surgical therapy for non-resolving COVID-19-associated acute distress respiratory syndrome (ARDS) and refractory hypoxemia. Google trends (GT) is an ongoing-developing web-kit providing feedback on specific general population's interests. This study uses GT to analyze the United States (US) general population interest in LT as COVD-19/ARDS salvage therapy. Methods GT was used to access data searched for the term lung transplant. The gathered information included data from January 2016 through October 2021 within US territories. Search frequency, time intervals, sub-regions, frequent topics of interest, and related searches were analyzed. Data was reported as search frequency on means, and a value of 100 represented overall peak popularity. Results The number of Google searches related to the term lung transplant has remained steady interest over time and surged in congruence with the appearance of COVID-19 in the US. From January 2016 until February 2019, interest has ranged from 29 to 58% (average 40%). Following the COVID-19 surge, average interest shifted up to 49%, with an all-time increase in November 2019, February 2020, and June 2020, of 90, 65 and 100%. Over time, the lead frequency of searches in sub-regions, metro areas, and cities, were Pennsylvania, Gainesville, FL, and Philadelphia, PA, respectively. Top related topic and top related query in search frequency, over time are electronic cigarette and lung transplant covid. At a glance, medical-relevant websites fail to provide adequate information for LT patient therapeutic education (PTE). Conclusion GT complements the understanding of interest in LT, especially in consideration of the COVID-19 pandemic's perspective. When properly interpreted, the use of these trends can potentially improve on PTE and therapy awareness via specific medical relevant websites. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3630 | Racial Disparities in Death Due to SARS-CoV-2 in the United States: An Analysis of the OPTN Database Purpose Racial disparities in severe acute respiratory syndrome coronavirus 2 (COVID) incidence and mortality have been demonstrated in the United States (U.S.). Transplant recipients represent a particularly vulnerable population given their comorbidities and immunosuppression. With this in mind, we aimed to evaluate the relationship between race and mortality due to COVID in lung transplant recipients. Methods Adult lung transplant recipients in the U.S. were identified using the Organ Procurement and Transplantation (OPTN) database. Multiorgan transplants and patients transplanted after December 31, 2020 were excluded. Recipients who were deceased or lost to follow-up prior to January 2020 were excluded as they were not at risk for death due to COVID. Lung transplant recipients were stratified by race (Black, Hispanic, White, and other race). Death due to COVID was the primary outcome while all-cause mortality and non-COVID mortality were secondary outcomes. Student's t-test, Chi-square test, and Cox proportional hazards models were used for comparisons. Results 17,198 recipients met inclusion criteria (1,598 Black, 1,353 Hispanic, 13,755 White, and 492 other race). 231 (1.34%) deaths due to COVID were reported. COVID mortality rate was significantly different (p=0.001) by race, being lowest in White recipients (n=162 [1.18%]) and highest in Hispanic recipients (n=30 [2.22%]). Non-COVID mortality was lowest in Hispanic recipients (n=129 [9.53%]) and highest in Black recipients (n=236 [14.77%]; p=0.008). There was no significant difference in all-cause mortality (p=0.054). After adjustment, Hispanic (HR=2.18; p=0.005) recipients experienced higher rates of mortality due to COVID compared to whites, but no significant difference in Black recipients (HR=1.73; p=0.066). See table 1 for additional predictors of death due to COVID. Conclusion Racial disparities in death due to COVID persist in U.S. lung transplant recipients, despite adjusting for social determinants of health. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3631 | Predictors of Humoral Response to COVID-19 Vaccination in Heart Transplant Recipients Purpose A reduced formation of IgG antibodies after COVID-19 vaccination has been reported in immunosuppressed heart transplant (HT) recipients. However, predictors of decreased humoral response in patients after heart transplantation remain elusive. Methods In 68 HT recipients who previously received two doses of a COVID-19 vaccine, anti-SARS-CoV-2 spike IgG (anti-spike IgG) were quantified (LIAISON® SARS-CoV-2 TrimericS IgG assay) during routine visits. IgG concentrations at or above 33.8 BAU/ml were considered positive, as defined by the manufacturer. Clinical characteristics including the immunosuppressive regimen were assessed. We performed regression analyses to identify predictors of humoral response. Results Of 68 HT recipients (44 (65%) male, median age 54 years (IQR 41-64), median time since HT 7.4 years (1.7-13.0)), 56 patients (82%) were treated with calcineurin-inhibitors, 35 (51%) with mycophenolate mofetil, 47 (69%) with everolimus, and 33 (49%) with prednisolone. 60 patients (88%) received two doses of an mRNA vaccine (50 patients BNT162b2, 10 mRNA-1273) and 8 patients (12%) two doses of the vector vaccine AZD1222. Two patients (2.9%) reported a prior COVID-19 infection. The median interval between the two vaccine shots was 41.5 days (35.0, 42.0). A positive humoral response 40 days after the second dose was detected in 26 patients (38%). Comparing the two types of vaccines used, antibody positivity rates were not significantly different (p = 0.10). Upon multivariate analysis, older patient age (p=0.006), shorter time since HT (p=0.022), male sex in combination with time since HT (p=0.023 for interaction effect), and use of prednisolone (p<0.001 in a tobit linear regression) were associated with lower log-transformed COVID-19 antibody titers. There was no detectable effect of vaccine type or of other immunosuppressive agents. Conclusion Older age, shorter time since transplantation, and treatment with prednisolone appear to be associated with lower anti-spike IgG concentrations after COVID-19 vaccination in HT patients. Overall humoral response rates were low (38%), regardless of the type of vaccine used or type of non-prednisolone immunosuppressive agent. Further studies are needed to determine the clinical effectiveness of COVID-19 vaccination in HT recipients and the need for specific booster vaccinations in this vulnerable population. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3632 | Impact of COVID-19 Infection Among Heart Transplanted Recipients: The Experience of a Latin American Center Purpose Heart transplanted recipients are at a high risk for COVID19 infection. Clinical presentation, complications, and related outcomes have been described worldwide. However, there is a paucity of data in Latin America. Methods Retrospective cohort of heart transplanted recipients followed at a center in Rio Grande do Sul, Brazil, between March 1st 2020 to October 1st 2021. Data are presented as absolute numbers (percentage) or median (interquartile). Results Among 62 recipients in follow-up, 21 (34%) were infected by COVID19. 58 (36-63) years, 67% male, body mass index of 26 kg/m², 48% with hypertension, 43% with chronic kidney disease, 5% diabetes, 3.1 (1.0-4.2) years post-transplant. Most common symptoms at presentation were fever (62%), myalgia (33%), cough (33%), and headache (33%). Dyspnea occurred in only 19% patients. Hospitalization was required for 13 (62%) with a time from symptoms onset to admission of 5 (1-12) days. In 38%, supplementary oxygen was needed, 19% required intensive care, and 10% mechanical ventilation. Main complications were bacterial pneumonia (38%), renal replacement therapy (19%), sepsis (10%), venous thromboembolism (10%), and pancreatitis (5%). Immunosuppression therapy was modified in 48% (in majority 89%, reduced). Median hospitalization time was 17 (8-28) days. Two (10%) patients died in hospital due to refractory hypoxemia and multiorgan dysfunction. The prevalence of COVID19 among heart transplanted patients was comparable to the general population in the state of Rio Grande do Sul (Figure 1) with a peak in December 2020. Conclusion COVID19 infection prevalence among heart transplanted recipients was elevated, presenting mostly with typical symptoms, and frequent hospitalizations, supplementary oxygen requirement, and complications. Although the COVID19 prevalence in Latin America was amongst the highest reported, in-hospital mortality among infected heart transplanted recipients was similar to previously published data worldwide. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3633 | Early Outcomes of Lung Transplantation for COVID-19 Related Lung Disease. Single Center Experience Purpose Lung transplantation (LT) is a lifesaving treatment for Covid-19 related lung disease with early outcomes similar to other indications. Methods Seven patients underwent LT for Covid-19 related lung disease at our center: 5 for ARDS and 2 for IPF exacerbation post SARS-CoV-2 infection. Results Seven patients (5 men) with single organ failure underwent bilateral LT. Median age was 47 years old. All ARDS cases had poor lung mechanics on invasive mechanical ventilation with radiographic evidence of lung fibrosis: pneumatocele, GGO, consolidations, subpleural reticulations and traction bronchiectasis. vvECMO was bridge to transplant in 5 cases (bridge to recovery in 2). Median ECMO duration for ARDS was 32 days (range 7-99). Median time to LT from Covid diagnosis was 59 days (Q1-IQ3, 54-62). Two patients were post-partum women with ARDS. Explanted pathology showed UIP, DAD, diffuse hemorrhage and one case of fibrosing NSIP. Pulmonary hypertension was seen in 4 cases. One patient did not survive. Organizing pneumonia and granuloma were present in this patient. Most ARDS patients were unable to tolerate lower sedation and consent by a substitute decision-makers was obtained. Post operative ECMO decannulation was possible in all cases. Induction, maintenance immunosuppression and antimicrobials were standard for our program. Donated grafts were from deceased brain death donors and negative for 2019-nCoV. Rehabilitation potential and strong social support were absolute inclusion criteria. All survivors have excellent lung function. Conclusion In the USA, over 130 LT have listed Covid-19 as the diagnosis indication. Although Covid-19 ARDS makes up for the majority of these LT, other diagnosis are post Covid pulmonary fibrosis and underlying fibrosis with SARS-CoV-2 induced exacerbation. LT for ARDS poses several challenges and is reserved for the minority of carefully selected patients dependent on extracorporeal life support. As others have reported, good short-term survival is described. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3634 | Humoral Response to SARS-CoV-2 mRNA Vaccine in Heart Transplant Recipients up to 4 Months After the Third Vaccine Injection Purpose Recent studies reported poor to moderate humoral response after 2 vaccine doses in heart transplant recipients (HTR). Currently, French authorities recommend 2 and 3 vaccine injections for transplant recipients with and without prior SARS-CoV-2 infection, respectively. This study aimed to evaluate level and durability of humoral immunity with this vaccination strategy. Methods This single-center cohort study included HTR followed at Paris Bichat hospital between January 2020 and September 2021. Analyses were performed using automated immunoassays (Abbot) to quantify anti-spike IgG (cut-off ≥ 7.1 BAU/mL) and anti-nucleocapsid IgG (cut-off index > 0.49). Categorical variables were described as number (%) and continuous variables with median (IQR). Results A total of 181 HTR (75.7% males, age 58 y [47-66]) transplanted between June 1990 and June 2021 were included. Median time from transplantation to first vaccine dose was 4.2 y [1.8-6.6]. 143 HTR (79%) had no SARS-CoV-2 infection history (HTRn) and 38 (21%) contracted the infection (HTRi) (56% before and 42% after vaccination initiation). After 2 vaccine doses, anti-S IgG seroconversion was observed for only 16% (n=12/76) of HTRn. Overall, anti-S IgG titers were lower in HTRn than in HTRi (0.5 [0.2-2.6] vs 578 [1.4-4449] BAU/mL, respectively, p=0.0001). The 3rd vaccine dose enabled to obtain 42% (n=33/72) of seroconversion among HTRn with median anti-S titers of 3.2 BAU/mL [0.4-35.0]. Only half seroconverters HTRn reached the 260 BAU/mL cut-off chosen by French authorities to define vaccination efficacy. Interestingly, these patients seem to have a sustained humoral response 4 months after the 3rd dose. Conclusion This study gives new insights on the effect of the 3rd vaccine dose in HTR with low rate of seroconversion and low titers of anti-S IgG but sustained humoral response when seroconversion occurs. Studies on vaccine efficacy against SARS-CoV-2 variants and cell-mediated immune response in this cohort are ongoing. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3635 | A Case of Prolonged Hospital Acquired COVID-19 Pneumonia in a Lung Transplant Recipient: Management and Outcome Introduction Lung transplant recipients are at increased risk of SARS-CoV2 infection due to immunosuppression and their management has yet to be standardized. We report a case of prolonged COVID-19 infection in a lung recipient acquired after transplant during the hospital stay. Case Report A 52-year-old lady with interstitial disease associated to systemic sclerosis underwent bilateral lung transplantation on 04/10/21. Donors and recipient microbiological tests for SARS-CoV2 were negative on molecular swabs performed before transplantation (04/07 and 04/10). Transplantation was uneventful and the recipient was extubated the subsequent day. Twelve days later, a surveillance molecular nose-pharyngeal swab was positive for SARS-CoV2. The positivity for subgenomic analysis revealed productive infection. At first monitoring biopsy, multiple foci of diffuse alveolar damage, significant cytopathic features of pneumocytes, microthrombi of capillaries, and extensive edema were highly suggestive of COVID-19 pneumonia. High viral load was also detected in lung biopsy by RT-PCR. She presented mild respiratory symptoms (cough with low oxygen supplementation) and the CT scan revealed an area of consolidation at the right lower lobe. Monoclonal antibody therapy (Bamlanivimab and Etesevimab) associated with remdesevir was started, IV immunoglobulins were administered while mycophenolate mofetil was discontinued. The patient was closely monitored until the nose-pharyngeal swab turned negative two months after the first positivity associated with a significant clinical improvement. At the last follow-up, five months after transplantation, she had good pulmonary function, no immunological disorders and no signs related to long COVID-19. Summary This is a case of prolonged hospital acquired COVID-19 related pneumonia in a lung recipient. Immunocompromized patients present a longer viral clearance. In this fragile population a strict clinical, radiological and histopathological monitoring associated with encouragement of vaccination are mandatory. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3636 | Comparison of LVAD Admissions Before and During the Era of COVID-19 Purpose LVADs have improved survival and quality of life in advanced heart failure (HF) patients. However, post implant hospitalization rates remain higher than ideal, potentially impacting patient access and scarce resource utilization during COVID-19. This study examines the number of hospitalizations, causes, and length of stay (LOS) during the COVID-19 era. Methods A retrospective review of 504 LVAD admissions from 9/2018 to 8/2021 was conducted. Admissions were divided into two-time periods each 18 months long: (a) Before COVID (9/2018 to 2/2020) and (b) during COVID (3/2020 to 8/2021). Admissions for cardiac transplantation were excluded. Admission rates (as events per patient-year, EPPY) were assessed as were the causes of admission with a 20% change (Delta, ∆) between eras considered clinically meaningful. Results A total of 153 patients were hospitalized with 504 total admissions. 274 (54.4%) were before COVID and 230 (45.6%) were during COVID. Overall LVAD admissions during the COVID era were lower (1.46 vs 1.63 admissions/patient-year, Table 1). During the COVID era, the risk of hospitalizations related to arrhythmias, device problems (low flow or device malfunction), and non-GI bleeding was increased by 60%, 40% and 21% respectively. At the same time, risk of admissions for gastrointestinal bleeding (GIB) and HF were lower by 20% and 33%, respectively. Average LOS between groups was not significantly different (p=0.21). Conclusion Overall unplanned LVAD admission rates in the COVID era were decreased. Those admissions that could not readily be managed in the outpatient domain for arrhythmias, device problems, and bleeding (non-GIB) were higher. However, GI bleeding (GIB) and heart failure (HF) hospitalizations were lower in the COVID era, likely related to extraordinary efforts to manage such adverse events in the outpatient setting or due to patient behavior changes during periods of quarantine. Other explanations appear less likely given that device use and outpatient management were similar between these 2 eras. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3637 | Breakthrough Infections and Low Mortality Observed in Heart Transplant Recipients Infected with COVID-19 at UC San Diego Purpose Management of COVID-19 has evolved over the course of the pandemic, with new therapies contributing to a decline in mortality in the general population. Immunosuppressed heart transplant (HT) recipients are at high risk of infection, but questions remain regarding their optimal management as these patients were excluded from many clinical trials on COVID-19 therapeutics and vaccines. Methods Retrospective search of electronic health records identified 41 HT recipients who tested positive for SARS-CoV-2 from February 1, 2020-October 13, 2021. Results Among the 41 HT recipients infected with SARS-CoV-2, 15 (36%) were monitored as outpatient, and of these, 4 received casirivimab/imdevimab and 1 received oral steroid. No COVID-19 related deaths were observed in this group. The remaining 26 patients (64%) were admitted for pneumonia or hypoxia. Five required admission to the intensive care unit (ICU), of which 3 required intubation and pressor support and 2 died (7.7% in-hospital mortality, 4.9% overall mortality). Of those admitted, 15 were treated with remdesivir and 7 received steroids. After vaccines were available in January 2021, 10 patients developed breakthrough COVID-19 occurring 2 weeks after the second Pfizer dose (n=6) and second Moderna dose (n=4). 8 of these patients were admitted for pneumonia or hypoxia and treated with COVID-19 directed therapies (4 received remdesivir, 2 received dexamethasone, 3 received casirivimab/imdevimab). 2 patients were monitored as outpatient where they received casirivimab/imdevimab. There was no severe illness or deaths observed in vaccinated patients. Conclusion We present 41 HT recipients at UCSD infected with COVID-19. By using outpatient isolation, monoclonal antibody infusions, and admission for treatment of hypoxic patients with remdesivir and steroid, we have demonstrated a lower mortality from COVID-19 compared to other studies on HT recipients. No mortality was observed in the breakthrough cases. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3638 | Outcomes of COVID-19 in Heart Transplant Recipients Purpose Data on outcomes after Covid-19 in heart transplant recipients are scarce and inconsistent. We sought to evaluate the early and late post-discharge outcomes in this patient population. Methods This case series includes 19 consecutive adult heart transplant recipients hospitalized for Covid-19 at our tertiary center between March 1, 2020 and April 30, 2021. After discharge, all patients were followed per standard post-transplant protocol for 6 months. Significant allograft dysfunction was defined as a decrease in LVEF ≥ 10% and myocardial damage was defined as at least 30% increase in troponin or NT-proBNP serum levels. CMV reactivation was defined as any positive PCR CMV requiring virostatic therapy. Results Of 19 recipients 15 (79%) were male with a mean age of 62±8 years and a mean time from transplantation of 4.5±3.4 years. 14 (73%) and 5 (26%) recipients had hypertension and diabetes, respectively. Immunosupressive (IS) regimen at the time of infection consisted of tacrolimus (TAC; mean C0 level 7.5±2.1 μg/mL), mycophenolate mofetil (MMF; mean dose 2052±359 mg) and steroids (mean dose 4.6±4.7 mg). During hospital management IS was reduced in 6 (31%) patients with a maintenence of TAC serum levels (mean C0 7.7±1.9 μg/mL pre-infection vs. 7.5±2.2 μg/mL during infection, P=0.75) and a decrease of MMF dose (2052±359 mg vs. 1906±657 mg, P= 0.01). In 11 (58%) patients we applied oxygen supplementation; however none required non-invasive or invasive forms of ventilation. During hospitalisation 12 (63%) recipients received hyperimmune plasma, 13 (68%) were treated with remdesivir (cumulative dose 600 mg), and 11 (58%) received steroid therapy (mean methylprednisolone dose 29±21 mg). All recipients survived to discharge (mean hospitalization time of 17.4±12.6 days) and to 6-month follow-up. We found no evidence of allograft dysfunction (LVEF 67±6% at baseline vs 68±7% at follow-up; P=0.88) or persistent myocardial damage (troponin: 22±28 pg/mL vs. 14±21 pg/mL; P=0.41 and NT-proBNP: 829±823 pg/mL vs. 817±940 pg/mL; P=0.96). CMV reactivation occured in 3 (16%) recipients and in 1 (5%) recipient a thrombotic event was noted. Conclusion Covid-19 outcomes in heart transplant recipients appear to be acceptable when managed in a tertiary center with dedicated heart transplant and Covid-19 facilities. Further data is needed to establish optimal Covid-19 management algorithms for this patient population. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3639 | Vaccine induced Coronay Antibodie-Mediated Rejection and Thrombosis in a Heart Transplant Pacient: A Case Report Introduction Heart tansplant (HT) recipients constitute a population at risk for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Efficay and safety of SARS-CoV-2 vaccine in this population is still yet to be established. It has been described, immune thrombotic thrombocytopenia, myocarditis and Guillain-Barre syndrome in individuals who received the ChAdOx1 SARS-CoV-2 vaccine. There are very few cases of acute rejection after SARS-CoV-2 vaccination post HT patients. We will describe a several outcome of heart function vaccine-induced. Case Report A 46-year-old heart transplanted male since 2015, started with persistent cough 15 days after a dose of adenoviral vector-based vaccine against SARS-CoV-2. As he had increased troponin and new left ventricular dysfunction, he underwent an endomyocardial biopsy, collected an panel reactive antibodies (PRA) and started pulse dose metylprednisolone. He developed an ischemic electrocardiographic alteration with a ST elevation and the coronary angiography found a thrombosis in the anterior descending coronary artery with no success with percutaneous treatment. Endomyocardial biopsy found no acute rejection, and PRA showed de novo donor specific antibodies (DSA). Despite treatment for antibodie-mediated rejection with plasmapheresis, human immunoglobulin and rituximab, he had a cardiogenic shock, refractory to inotropic support and intra-aortic balloon pump, requiring peripheral VA ECMO. Regardless of initial hemodynamic response and partial recovery of biventricular function, patient could not stand weaning from ECMO and inotropes. After rejection therapy, PRA showed no antibodies and patient was included in HT list and had a retransplant after 16 days without complications. Summary To the best of our knowledge, this is the firts report of antibodie-mediated rejection in heart-transplant patient with thrombotic complication after ChAdOx1 SARS-CoV-2 vaccine. Although vaccination remains the main approach of preventing SARS-CoV-2 infeccion, transplant recipients were not included in clinical trials, so its safety remains unknown in this population. More studies are needed in order to increase knowledge about vaccine outcomes in these individuals. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3640 | Implementation of In-Clinic SARS-CoV-2 Vaccination in Advanced Heart Failure, Lung Disease and Transplant Clinic Purpose Vaccine hesitancy is a hurdle to achieving full vaccination against SARS-CoV-2 in the U.S. In an effort to address vaccine hesitancy among the high-risk group of advanced heart and lung disease and post-heart and lung transplant patients, we implemented an in-clinic vaccination program. Starting 9/9/2021, we offered the Pfizer/BioNTech SARS-CoV-2 mRNA vaccine in clinic to eligible individuals, including patient family members who were patients in our healthcare system. We sought to describe the results of the first month of implementing an in-clinic SARS-CoV-2 vaccination effort. Methods We reviewed the experience of providing SARS-CoV-2 vaccination in clinic during the first four weeks of the program (9/9/2021-10/7/2021). Recipients’ charts were reviewed for clinical details. We also compared demographics of the in-clinic recipients to those of patients who received inpatient dosing of the same vaccination at our hospital. Results From 9/9-10/7/2021, 222 SARS-CoV-2 vaccines were administered in clinic. Average age of recipients was 60 (±15) years. 64 (29%) were given in the heart failure/transplant clinic; 107 (48%) were given in the advanced lung/transplant clinic; 50 (22.5%) were administered to healthcare workers, 10 (4.5%) were administered to family members of patients. 50 (22.5%) were post-transplant patients. Nineteen (8.6%) were the patients’ first dose; 200 (90%) were third doses (booster or third dose for immune compromised). During this time period, 12 doses of vaccine were discarded due to expiration after thawing in our outpatient setting. During the same period, 115 inpatient doses of the vaccine were given. Average age of inpatient recipients was 51 (±17) years. Ninety-one (79%) of inpatient administrations were first doses. Conclusion Inpatient vaccination was more likely to reach younger and unvaccinated patients, while in-clinic vaccination in advanced heart/lung disease outpatient clinic was more likely to complete a three-dose series for immune-compromised patients or booster dosing for high-risk patients/staff. Additional study on the impact of offering SARS-CoV-2 vaccination in-clinic on combatting vaccine hesitance is necessary. This study is limited because we only provided Pfizer/BioNTech vaccines; different effects may be seen in clinics that also offer other FDA approved SARS-CoV-2 vaccines. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3641 | Challenges in Heart Transplantation in COVID-19 Pandemic New Biopsy Protocol a Single Center Experience Purpose Orthotopic heart transplantation remains the treatment of choice for endstage heart failure. In the face of the COVID19 pandemic, managing patients with advance HF before and after OHT has become an increasing challenge in both: in immunosuppression treatment and postoperative managements including biopsy protocol Methods We retrospectively evaluated the outcomes of all patients who underwent OTH from March 2020 to February 2021 at Silesian Heart Diseases Center, Zabrze, Poland. Due to global pandemic of COVID19 several challenges including reduced numbers of myocardial biopsies were done Results 88 patients (67 male, 21 female) underwent OHT. During this period of time the COVID-19 infections were at high level in Poland. Both donor and recipients were tested for SARSCOV2 within 48 hrs of the procedure and none tested positive. We employed strict protocol of hand hygiene, PPE usage, isolation and regular staff PCR testing. We elected to reduce the routine myocardial biopsy rate from 4to1 in first month in order to reduce exposure of the patients to the potential of COVID19 disease. All patients received a standard triple regimen of calcineurin inhibitor (tacrolimus), antimetabolite (mycophenolate mofetil) and methylprednisolone. The level of immunosuppressive medications was done every day. 20 of 88 patients underwent first biopsy at 7 - 10 days post-operatively, and 3 more biopsies at one-month interval. The first myocardial biopsies did not demonstrate acute cellular rejection. We observed acute cellular rejection (2R grade) among 3 patients (15%) in second myocardial biopsy and they were treated with methylprednisolone 1gram iv for 3 days and after we return to previous prednisone dose. Third myocardial biopsy did not demonstrated acute cellular rejection. All of patients were discharged from the hospital at day14 days, and followed up in OPD once a week till the next admission. Ultrasonography including strain echo parameters of left and right ventricle, lab tests and the level of immunosuppression were done during each OPD visit. Conclusion OHT recipients who underwent reduced numbers of myocardial biopsies appear to have reasonable outcomes (including adequate home support) compared to recipients with standard protocol. We have shown that successful heart transplantation could be performed during of COVID19 disease pandemic. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3642 | Breakthrough COVID-19 Infections in Heart Transplant Recipients: A Case Series Purpose Heart transplant (HT) recipients are at high risk for Covid-19 infection, and data are limited about the efficacy of vaccination in this unique population. We sought to describe the presentation and outcomes of a cohort of HT patients with Covid-19 infection despite prior vaccination. Methods Retrospective chart review of 250 adult HT recipients followed at the University of Southern California identified 7 individuals with PCR-proven Covid-19 infection after full vaccination (no patients received booster doses) between December 1st, 2020 and October 1st, 2021. Baseline clinical characteristics, serial echocardiographic parameters, laboratory testing, medication regimens, clinical presentation and clinical course were collected. Results A total of 237 were vaccinated with an incidence of 7 breakthrough infections (3%). Patients were predominantly male (71%) with a median age of 50 years old. The average BMI was 32.89. Hypertension (86%), diabetes (57%), and hyperlipidemia (43%) were common. Nearly all (71%) of patients were on 3 classes of immunosuppressive therapy, and nearly half (43%) had a history of rejection. Five patients (72%) received Pfizer-BioNTech, 1 patient (14%) received Moderna, and 1 patient (14%) received the Johnson & Johnson vaccination. One patient had a prior history of Covid-19 infection before vaccine availability. Patients were on average 6.74 (3.8-8.4) years out from transplantation. The most common presentation was dyspnea (71%), cough (57%), and fever (43%). Seventy one percent were hospitalized, and 29% were admitted to the ICU. Treatments varied, with equal rates of antibiotics (29%), steroids (29%), and remdesevir (29%). However the most common treatment was monoclonal antibody therapy (57%). One patient, vaccinated with a single Johnson & Johnson shot, died lending an 86% survival rate for breakthrough infections after Covid-19 vaccination. Conclusion In a single center experience 7 patients with a history of heart transplant and breakthrough Covid-19 infection were identified and found to have an 86% survival rate. Further investigation is needed assessing the efficacy of the Covid-19 vaccination in this population, as well as evaluation for differential outcomes between the various vaccine options. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3643 | A Case of Cardiogenic Shock in a Young Adult with COVID-19 induced Multisystem Inflammatory Syndrome Introduction Multisystem inflammatory syndrome (MIS-C) is associated with the novel coronavirus (COVID-19). Children and young adults with MIS-C typically present with fever, abdominal pain, nausea, vomiting, and occasionally, respiratory symptoms. Myocardial dysfunction (as measured by TTE, elevated troponin, or elevated brain natriuretic peptide [BNP]) has been reported in 51-90% of these patients. Case Report An 18-year-old male without significant medical history was transferred to the Cardiovascular Intensive Care Unit with cardiogenic shock after presenting with headache, myalgias, sore throat, nausea, and vomiting. Initial workup revealed hypotension, tachycardia, and positive SARS-CoV-2 IgG antibodies. Transthoracic echocardiogram (TTE) showed severe biventricular failure with left ventricular ejection fraction (LVEF) of 26%. Vasopressors were started for blood pressure support. Right heart catheterization (RHC) was consistent with cardiogenic shock. Impella CP percutaneous left ventricular assist device was placed. The patient developed hypoxemia and tachypnea. He was intubated and underwent cannulation for veno-arterial extracorporeal membrane oxygenation (VA ECMO). He was also started on continuous renal replacement therapy (CRRT) for acute anuric renal failure. Endomyocardial biopsy revealed benign myocardium. Vasopressors were weaned and repeat TTE on day 3 revealed LVEF of 34%; subsequent TTE on day 5 showed recovery up to 53%. The Impella device was removed, VA ECMO was decannulated, and the patient was extubated. He improved clinically over the next weeks with normalizing vital signs, inflammatory markers, respiratory status, and renal function. The patient was discharged on day 28, about six weeks after symptom onset. TTE prior to discharge revealed mild LV hypertrophy and normal systolic function. Summary As illustrated in this case, timely recognition of cardiogenic shock is critical. This patient developed acute-onset cardiogenic shock, which required early escalation to temporary mechanical circulatory support. Additionally, this patient's care was complex and the case highlights the importance of early coordination between teams. Meetings were held nearly daily, with collaboration contributing to a multidisciplinary workup and treatment plan that ultimately led to the full recovery of this young patient. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3644 | Obese Lung Recipients May Be Susceptible to Severe COVID-19 Outcomes Compared to Controls Purpose Obesity is thought to increase COVID-19 (C19) related morbidity and mortality in nontransplant patients; however, the data in lung transplant literature are lacking. We aimed to study impact of body mass index (BMI) on outcomes of lung transplant recipients (LTR) with C19. Methods From March 2020 to August 2021, 91 lung recipients with C19 were included and classified as controls (BMI <30 kg/m2) and obese (BMI ≥30 kg/m2) at the time of LT listing. Primary outcome was death. Secondary outcome was C19-related medical morbidity. Cox proportional hazard analysis and Kaplan-Meier method were used. Results Controls (69%, n=63) and obese (31%, n=28) subjects were comparable in terms of baseline characteristics before C19 onset. Compared to controls, obese subjects tended to have more severe inflammation and a higher prevalence of hypoxemia, requirement of ICU, mechanical ventilation, and death (Table 1). Also compared to controls, the risk of death tended to be higher and probability of survival tended to be lower in obese subjects (HR: 1.971 [0.956-4.065], p=0.066 and 73% vs 53.6%, p=0.061, respectively; Figure 1). However, coinfections and post-C19 allograft function were comparable between the two groups (Table 1). Of note, mycophenolate was stopped or reduced upon/during hospitalization in both groups alike. Conclusion In our study, obese LTRs trended toward an increased risk of death from C19 compared to controls. This is the first data on the impact of obesity on C19 in LTRs. The role of leptin as a pro-inflammatory substance can be speculated. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3645 | WITHDRAWN | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3646 | Poke Not Prod: First Canadian Experience Using Donor-Derived Cell Free DNA to Replace Endomyocardial Biopsy During COVID-19 Purpose After a heart transplant (HT), non-invasive methods for rejection surveillance minimize the need for endomyocardial biopsies (EMBx). We describe the first experience with combined use of genetic expression profiling (GEP) and donor-derived cell-free DNA (dd-cfDNA) testing in Canada as part of a quality improvement project to minimize patient risk during the COVID pandemic. Methods Adult outpatients at least 6 months after HT were screened from May 2021 to July 2021 to have their routine EMBx replaced by a combination of GEP and dd-cfDNA. Demographics, modification of immunosuppression (IS) and outcomes (hospital admission, rejection, and need for EMBx) were collected. Results Among 90 patients, 31 (33%) were enrolled, and 37 non-invasive tests were performed. The median time after HT was 2 years and patients were predominantly Caucasian (52%) and male (68%). 53% had a history of acute cellular rejection during the first year and 32% had cardiac allograft vasculopathy. Of the tests performed, 23 (60%) were - GEP / - dd-cfDNA, 10 (27%) were + GEP / - dd-cfDNA, 4 (11%) were - GEP / + dd-cfDNA and none were + GEP / + dd-cfDNA. Being bridged with a VAD (OR = 5.5, p=0.034) and a history of a previously treated CMV (OR = 16.0, p=0.003) were associated with a positive GEP and a negative dd-cfDNA result. Having received a COVID vaccine in the last 3 months did not affect GEP results (GEP was positive in 23.8% after vaccination vs 33.3% in non-vaccinated patients, p=0.690; average GEP score 29.8 vs 30.7, p=0.673). The 4 patients with a + dd-cfDNA (range 0.19 - 0.81%) underwent an EMBx with no significant cellular or antibody mediated rejection, thus avoiding 89% of the EMBx. No unscheduled clinic visits, emergency department or hospital admissions were recorded. After non-invasive testing, the IS was reduced in 16 cases (43.2%). IS was reduced in in 59% of patients with negative concordant tests (- GEP / - dd-cfDNA), 30% in patients with + GEP / - dd-cfDNA and no reduction in IS occurred in those with + dd-cfDNA. Conclusion The combination of GEP and dd-cfDNA for rejection surveillance allowed for a marked reduction in EMBx (89%) and for a personalized downtitration of IS without adverse events in the short term. The use of non-invasive rejection surveillance testing was an effective strategy to avoid hospital contact for HT recipients during the COVID-19 pandemic. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3647 | Efficacy and Safety of mRNA SARS-CoV-2 Vaccination in Heart Transplant Recipients Purpose Data on immunologic response to SARS-CoV2 vaccination in heart transplant recipients are scarce. We investigated the efficacy and safety of mRNA SARS-CoV2 vaccination in this patient population. Methods In a retrospective single-center study we included 54 consecutive adult heart transplant recipients who received 2 doses of mRNA SARS-CoV2 vaccine between January 1 and June 30, 2021. All patients were followed for 112±28 days after the second dose. At the end of follow-up we measured humoral response to SARS-CoV2 by assessing total antibody levels to the receptor-binding domain of SARS-CoV2 spike (S) protein using anti-RBD immunoassay. Anti-S antibody serum levels ≥250 BAU/mL were considered protective. At the same time, cellular response was measured by the IFN-γ response to S-peptide stimulation of recipient T lymphocyte populations. Protective cellular response was defined as more than 0,3% of IFN-γ responsive T cells. Results Of 54 recipients, 44 (81%) were male with a mean age of 63±8 years and a mean time from transplantation of 6.6±4.0 years. Immunosupressive regimen consisted of tacrolimus (mean C0 level 7.4±1.7 μg/mL), mycophenolate mofetil (mean dose 2120±419 mg) and steroids (mean dose 2.5±0.9 mg). The majority of patients received BTN162b2 vaccine (83%), and 17% of recipients were vaccinated with mRNA-1273. During follow-up, a humoral response was present in 24 (44%) of the recipients (median anti-S serum level 35.5 BAU/mL). We found no difference in humoral response between patients receiving BNT162b2 and mRNA-1273 vaccine (median anti-S serum level 68.3 BAU/mL vs. 15.5 BAU/mL, P=0.81). Protective humoral response was observed in 6 (11%) of the recipients (median anti-S serum level 557 BAU/mL). A cellular response to vaccine was present in 3 (6%) of the recipients; all 3 displayed a protective level of reponse. No recipients developed simultaneous protective humoral and cellular responses. Recipient age was the only predictor of protective humoral response (55±11 years in responders vs. 65±8 years in nonresponders; P=0.01). In 3 (6%) recipients we found worsening of allograft function requiring hospital admission, which occured within 1 month after receiving the second dose of vaccine. Conclusion In heart transplant recipients, mRNA SARS-CoV2 vaccination appears to be of limited efficacy and may, in some cases, be associated with worsening of allograft function. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3648 | Persistent Viral Detection After Resolution of COVID-19 in Lung Transplant Recipients Introduction Persistent detection of SARS-CoV-2 viral particles has been seen in the absence of symptoms in other solid organ transplant recipients. We report this unique phenomenon in lung transplant (LTx) recipients. Case Report We present the following cases of prolonged viral shedding in 3 LTx recipients: Patient A - 68-year-old female, bilateral LTx recipient for COPD (02/2020), Patient B - 65-year-old male, bilateral LTx recipient for IPF (07/2020), and Patient C - 64-year-old female, bilateral LTx recipient for COPD (08/2020). There were no major intraoperative complications, and the maintenance immunosuppression regimen was the same across patients. Patient A contracted COVID-19 at our center 10 months after transplant, reporting upper respiratory infection symptoms, after initially presenting with persistent headaches and diagnosed with posterior reversible encephalopathy syndrome. Patients B and C presented to clinic with myalgias and mild dyspnea at one and five months after transplant, respectively. SARS-CoV-2 was detected by RT-PCR of nasopharyngeal specimens in all patients. Chest CT demonstrated typical findings of COVID-19 pneumonia in all patients. Patients A and C received remdesivir and belatacept and were discharged home on days 5 and 7, respectively; Patient B received remdesivir and convalescent plasma and was discharged home on day 8. All were in stable clinical condition on room air. All 3 patients had persistently positive nasopharyngeal swab samples up to four weeks after hospitalization, despite absence of symptoms. We did not augment immunosuppression in these patients. Imaging findings during and after the infectious course are shown in Figure 1. Patient C has persistent lower lobe radiographic changes after COVID-19. Summary LTx recipients may exhibit prolonged viral shedding up to at least 1 month despite resolution of symptoms. Well-established cohort studies are needed to elucidate the full duration of viral shedding in this group. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3649 | Short-Term Outcomes of Lung Transplantation for COVID-19 ARDS: A Single Center Experience Purpose The outcomes of lung transplant (LTx) for COVID-19 related lung disease are continuing to be examined. This study describes our experience in the first 7 cases. Methods This study included all patients received double LTx (DLTx) for COVID-19 acute respiratory distress syndrome (ARDS) between November 2020 and October 2021. Patient pre-LTx and perioperative characteristics as well as post-LTx outcomes are presented. Results Seven patients underwent DLTx for COVID-19 ARDS. All required mechanical ventilation (MV) pre-LTx. Six patients were male (85%), 5 Hispanic (71%), with a median age of 48 (IQR 40-53) and median body mass index of 23.6 (IQR 21.7-25.6). Six patients (85%) were on veno-venous extracorporeal membrane oxygenation (VV-ECMO) pre-LTx (one conversion from VV to veno-arterial (VA)). Median duration of MV and ECMO pre-LTx was 140 days (IQR 82-165) and 71.5 days (IQR 58-149), respectively. Two patients developed acute kidney injury pre-LTx requiring continuous renal replacement therapy (CRRT). Median time from listing to transplant was 17 days (IQR 10-24). ECMO was discontinued in all but 1 patient post-LTx. Median length of stay in the hospital post-LTx was 30 days (IQR 15-57). All were discharged from the hospital (43% to rehabilitation facility). Two patients on pre-LTx CRRT remained hemodialysis dependent and had multi-drug resistant (MDR) bacterial infections post-LTx. One readmission occurred for presumed rejection, aspiration and infection with MDR Klebsiella now requiring oxygen. All surgical pathology showed diffuse interstitial fibrosis consistent with the fibrotic sequelae of alveolar damage due to COVID-19. At 3-month follow-up, 6 patients (85%) did not need supplemental oxygen and had good pulmonary function. Conclusion Lung transplantation for COVID-ARDS is feasible. However, pre-transplant multi-system involvement may be associated with a protracted post-LTx stay and MDR infection. Further studies are needed to assess the long-term outcomes in this cohort. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3650 | Immunogenicity of Two Doses of ChAdOx1 nCoV-19 Vaccine in Lung Transplant Recipients Purpose Lung transplant recipients (LTR) are at higher risk to develop severe SARS-CoV2 pneumonia, due to the immunosuppressive regimen, which further hampers their immune response to vaccination. Indeed, is has been shown that LTR mount weak antibody response after SARS-CoV2 mRNA vaccination. Nevertheless, the immunogenicity of ChAdOx1 nCoV-19 vaccine has not yet been studied in LTR. Methods 49 lung-transplant SARS-CoV2 seronegative recipients were enrolled in a prospective cohort study and received the two doses regimen, day 0 and day 90, of the ChAdOx1 nCoV-19 vaccine. Immune response was assessed by measuring total anti-SARS-CoV2 antibodies (Anti-SARS-CoV2 total Ig immunoassay, Ortho Clinical Diagnostics, USA) at D0, D24, D84, D112 and D180. Endpoints At D180, 25% of LTR had positive total antibody levels (positivity threshold, > 1 (sample signal/threshold value). Age, CMV status, gender and initial respiratory disease had no influence on the immune response. Immune response was improved in patients whose immunosuppressive regimen did not include mycophenolate mofetil (53% versus 0%, p < 0.0001), and in patients who were transplanted for more than 18 months (0% versus 41%, p < 0.05), probably due to more aggressive immunosuppressive regimen in recently transplanted patients. Conclusions Immunogenicity of ChAdOx1 nCoV-19 vaccine is poor in LTR, with only one in four patients mounting significant anti-SARS-CoV2 immune response at D180. Of note, according to expert recommendations, most LTR received an heterologous booster dose with a SARS-CoV2 mRNA vaccine (BNT162b2). Additional serological analyses are planned to decipher whether vaccinal response is improved after the third dose in LTR. Results will be updated accordingly and presented at the 42nd ISHLT Congress. | J Heart Lung Transplant | 2022 | CORD-19 |
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