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Last Update: 18 - 01 - 2023 (628506 entries)
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| Title | Venue | Year | Impact | Source | |
|---|---|---|---|---|---|
| 3651 | Antibody Responses to COVID-19 Vaccination in Left Ventricular Assist Devices Purpose Left ventricular assist device (LVAD) implantation is associated with immune dysregulation and common occurrence of major infections. Whether humoral responses to COVID-19 vaccination are protective and durable in LVAD patients is uncertain. Methods We conducted a prospective single-center cohort study in LVAD patients without prior COVID-19 infection, who received 2 doses of BNT162b2 (Pfizer) or mRNA-1273 (Moderna) or 1 dose of Ad26.COV2.S (J&J) COVID-19 vaccines. Serologic testing was performed at 3, 6, and 9 months after COVID-19 vaccination using the Roche Elecsys anti-SARS-CoV-2 spike enzyme immunoassay (range <0.4 to >2500 U/mL [positive ≥0.8]), which tests for antibodies against the spike protein's receptor-binding domain (RBD). Results In March 2021, 45 LVAD patients (80% HeartMate 3) were enrolled and 24 (53%) received Pfizer vaccines, 17 (38%) Moderna, and 4 (9%) J&J at a median duration of LVAD support of 34 months (1-114). Most were male (89%) and white non-Hispanic (71%) persons with median age 62 years (23-78); 26 (58%) had diabetes, 16 (36%) had chronic kidney disease (CKD), and 3 (7%) were on immunosuppressive medications. Median absolute lymphocyte count (ALC) at the time of their vaccine was 1.26 K/uL (0.54-3.41). All patients developed a detectable anti-RBD antibody after vaccination, which began to wane after 3 months. The median anti-RBD IgG titers were 1132 U/mL, 360 U/mL, and 286 U/mL at 3, 6, and 9 months, respectively, post-vaccination (Figure). Age > 60 years, ALC < 1.5 K/uL, and history of CKD were associated with lower median anti-RBD IgG titers at 3, 6, and 9 months. Moderna vaccine recipients had the highest and J&J the lowest anti-RBD IgG titers at 3-months. In the 9-month study period, there were no vaccine-related serious adverse events or breakthrough COVID-19 infections. Conclusion LVAD patients exhibit a robust humoral response to COVID-19 vaccination without breakthrough infection. Further research to evaluate cellular responses to COVID-19 vaccination in LVAD patients is warranted. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3652 | The United States Experience of Lung Transplantation in Recipients with COVID-19 Fibrosis: A UNOS/OPTN Analysis Purpose Coronavirus Disease 19 (COVID-19) is a novel cause of end-stage fibrotic lung disease. Data has been limited to case series and single center reports with regards to outcomes in this unique cohort of patients. We sought to investigate the largest experience to date in patients with COVID-19 fibrosis (CVF) who underwent lung transplantation. Methods The United Network for Organ Sharing (UNOS) database was queried for all adult patients (≥18 years old) who underwent isolated lung transplantation between 2018 and July 2021. Recipients diagnosed with CVF were identified and compared to those with idiopathic pulmonary fibrosis (IPF). The IPF cohort included recipients from 2018, in the pre-COVID era. Baseline demographics, perioperative factors, and 30-day outcomes were examined. Results A total of 931 recipients were included in this study, 868 (93.2%) and 63 (6.8%) were IPF and CVF, respectively. IPF recipients were on average older (65 vs. 56 years, p<0.001), white race (83% vs. 51%, p<0.001), and less likely to be male (73% vs. 86%, p=0.04). BMI was similar between the IPF and CVF, 27.6 and 27.2 kg/m2, as was the mean PAP 24 and 21 mmHg. The CVF cohort had lower predicted FVC (32% vs. 47%, p=0.01), and had less tobacco use (36% vs 61%, p<0.001). Mean creatinine level was clinically similar, though statistically higher in the IPF cohort, (0.83 vs 0.64, p<0.001). CVF recipients were on the waitlist for a shorter median duration (10 vs 32 days, p<0.001) with a higher LAS (85 vs 41, p<0.001). Notably, more CVF recipient were be on ECMO at time of listing (29% vs 2%, p<0.001) and require ventilatory support (27% vs. 2%, p<0.001). CVF recipients were more likely to receive a double lung transplantation compared to IPF (83% vs 64%, p=0.002), with similar ischemia times, 5.5 vs 5.1 hrs (p=0.17). Mortality at 30 days was comparable between CVF and IPF (7.0% vs. 2.3%, p=0.09), though 20 patients in the CVF cohort had missing data. Conclusion Patients with end-stage lung disease secondary to CVF are higher acuity, and more likely to require ECMO and ventilatory support as a bridge to lung transplantation. Early mortality, while comparable to non-COVID related fibrotic lung disease, remains almost 3 times higher with CVF. In the era of publicly reported survival outcomes, the transplant community may need to reconsider how we approach this new and devastating diagnosis of CVF. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3653 | Shifting Paradigms in ECMO Support for Severe COVID-19 Respiratory Failure Result in over 80% Hospital Survival in 2021 Purpose The role of ECMO support for COVID-19 patients with severe respiratory failure has evolved over the course of the pandemic. Rapid exchange of experience among caregivers led to changes in ECMO support strategies, and patient management that resulted in improved outcomes in recent pandemic waves. We present our 18 months experience comparing patient outcomes in 2020 vs 2021. Methods We present a single institution retrospective analysis of patients receiving ECMO for COVID-19 ARDS. Patient data include demographics, comorbidities, time from admission to intubation and to initiation of ECMO support, type and duration of ECMO support, major patient and ECMO circuit complications, and hospital survival to discharge, or acceptance/transfer to lung transplant center. Results A total of 20 patients were identified for analysis. The cohort was predominantly male (65%) with an age and body mass index (BMI) average of 49.2±10.2 years and 32.8±5.9 kg/m2, respectively The average length of stay was 44.8±16.3 days and 55%. Most common support mode was veno-venous ECMO (90%) with a right femoral vein/right internal jugular cannulation (60%), and 75% required ECMO-circuit exchange. Comparing patients supported in 2020 vs 2021, time from intubation-to-ECMO, admission-to-tracheostomy, and ECMO-to-discharge were statistically significant (p=0.015; 0.014; 0.05; CI 95%). Overall survival rate was 65%, with a significant increase to 83% in 2021. Congruently, 55% of all discharged patients underwent ambulatory physical therapy treatment. ECMO-related complications were observed in 30% of the patients, including cardiovascular accident (CVA) (20%), clotting of the system (15%), and hemorrhaging from tracheostomy requiring revision (20%). When comparing groups, early tracheostomy was related to improved survival (p=0.014, CI 95%). 35% patients were accepted / transferred for lung transplantation. Conclusion Changes in management of patients receiving ECMO for COVID19 ARDS, including anticoagulation with bivalirudin, early tracheostomy and physical therapy, conversion to VAV ECMO, and referral to lung transplant resulted in 60 day hospital survival of 83% in 2021. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3654 | Comparing Outcomes of COVID-19 vs NonCOVID-19 Lung Transplant Recipients on ECMO as a Bridge to Transplant Purpose Despite advances in treatments for COVID-19, a subset of patients develop end stage lung disease, necessitating lung transplantation. However, COVID-19 ARDS often requires prolonged intubation with sedation and paralytics, resulting in profound deconditioning. As such, extracorporeal membranous oxygenation (ECMO) is a useful bridge to transplant to allow for a wakeful state and facilitate rehab. This study compares outcomes among patients with COVID-19 and nonCOVID-19 lung disease placed on ECMO as a bridge to transplant. Methods All patients on veno-venous ECMO prior to lung transplantation at a single center from Jan 2020 - Oct 2021 were identified. Patient characteristics and post-transplant outcomes were abstracted for comparison. Results A total of 7 patients were identified in the COVID-19 (C) cohort and 11 in the nonCOVID-19 (NC) cohort. Age and LAS at transplant were similar (Table 1). As expected, total duration on ECMO was longer for C cohort patients (85.4 vs 14.5 days). Patients in the C cohort had longer ischemia times and more returns to the OR within 72 hours of transplant (71% vs 45%). Rates of hemodialysis within 30 days of transplant were lower in the C cohort (14% vs 18%). Further, C cohort patients had higher rates of detectable donor specific antibodies by IgG (71% vs 55%), though all were negative by C1q and compatible cross matches. While total and ICU lengths of stay were longer in the C cohort, this group had a shorter post-transplant hospital length of stay. Median time post-transplant was 212 days for the C cohort and 154 days for the NC cohort; survival was 100% for both groups at follow up. Conclusion For patients with COVID-19 ARDS, ECMO is a useful bridge to transplant to mitigate complications associated with prolonged mechanical ventilation. These preliminary data suggest prolonged periods of ECMO pre-transplant do not result in significant adverse events post-transplant. Additional analyses of graft function and survival at 6 and 12 months are ongoing. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3655 | Transplanting Thoracic COVID-19 Positive Donors: Overcoming the Pandemic Purpose The COVID19 pandemic has exacerbated the thoracic organ shortage. Safe donation from COVID19 infected donors would increase the donor pool. Methods We present our institutional protocol and early results for thoracic organ transplantation using COVID19 positive donors. Endpoints To date, we performed 10 thoracic organ transplants in 9 recipients using organs from COVID19 positive donors (9 hearts;1 pair of lungs). Patient and graft survival to date is 100%, 91%. Hearts were procured from donors testing positive for COVID19 on upper and/or lower respiratory tract specimens, provided severe COVID pneumonia or myocarditis was not the cause of death, and hypercoagulable complications were absent. Lungs were procured only if donors were first positive >20 days prior and were PCR-negative on bronchoalveolar lavage. Cycle threshold, duration of infectivity and urgency of recipient need were considered in addition to routine evaluations.8/10 donors were first detected positive during terminal illness, yet no heart recipients acquired COVID19 infection through transplant and no unexpected rejection occurred. 1 heart-liver recipient required a redo heart transplant due to massive hemorrhage followed by hypercoagulability and coronary thrombus. An RV biopsy from the donor heart demonstrated ischemic changes and SARS-CoV-2 immunohistochemical findings suspicious for myocyte infiltration. Urgent re-transplantation was successfully completed utilizing a heart from another COVID19+ donor with no recurrence of hypercoagulability. One patient received lungs from a donor with mild COVID19, first detected 38 days earlier, yet still COVID19 positive on nasopharyngeal swab but not on BAL. No procurement or care team members became infected with covid as a result of this protocol. While limited, our experience to date supports that use of hearts from COVID19 positive donors is safe and effective. Lung transplantation from COVID19 positive donors is unresolved but may be cautiously pursued under the restricted circumstances. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3656 | Hemodynamic Effects of COVID-19 Vaccination in Hospitalized Patients Awaiting Heart Transplantation Purpose The American Society of Transplantation and the International Society of Heart and Lung Transplantation recommend COVID-19 vaccination of transplant candidates to maximize immunity, as vaccination after initiation of immunosuppression may confer only partial immunity. However, there are concerns about the impact of vaccine-induced systemic inflammatory responses in critically ill patients with variable hemodynamic states. We aim to explore the safety of pre-transplant vaccination by examining the immediate impact of COVID-19 vaccination on the hemodynamics of hospitalized patients awaiting transplant. Methods A retrospective chart review at a major transplant center was conducted among all heart transplant recipients from January 2021 through September 2021 who were hospitalized and listed or under consideration for listing for transplant at the time of COVID-19 vaccination. Primary outcomes included vital signs, hemodynamic parameters from pulmonary artery catheter-derived measurements, and changes in inotrope/vasopressor infusion rates. Data were extracted at fixed time points 24 hours before and up to 72 hours after vaccination. Given the small sample size and exploratory study nature, only univariate analysis was performed. Results Of the 50 patients who received heart transplants at our center from January 2021 through September 2021, 37 patients were vaccinated against COVID-19. 13 of those patients were vaccinated before transplant while hospitalized, and 10 of those 13 patients had a pulmonary artery catheter in place at the time of immunization. No significant changes in vital signs (blood pressure, heart rate), hemodynamics (cardiac index, pulmonary artery pressures, systemic vascular resistance), or vasopressor/inotrope infusion rates were observed after vaccination. Conclusion In this exploratory review of COVID-19 vaccination in heart transplant candidates, we did not detect any notable changes to hemodynamics in the first 72 hours after immunization. Although further investigative research is needed to assess COVID-19 vaccine safety comprehensively in patients with advanced heart failure, the absence of notable hemodynamic changes in this cohort of heart transplant candidates encourages the continued use of COVID-19 vaccination among hospitalized patients with advanced heart failure who are awaiting transplant. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3657 | Variances in Humoral Responses to Different Spike Protein Domains After SARS-CoV-2 Vaccination in Lung and Heart Transplant Recipients Purpose Solid organ transplant recipients are lacking an adequate immune response to SARS-CoV-2 vaccination. Therefore, these patients are still at risk and potentially in need of booster vaccinations. Furthermore, it is important to differentiate between the recipients of distinct organs. The efficacy of SARS-CoV-2 vaccination is usually examined via antibodies specific for the spike protein with assays containing the S1 and receptor-binding-domains (RBD) and rather rarely the S2 domain. To gain information about the humoral response in Tx recipients, it is feasible to compare the immunogenicity of these three domains. To address this, we compared the IgG antibody levels specific for the three spike protein domains in heart (HTx) vs lung (LTx) transplant recipients. Methods Blood plasma 4-6 weeks after the second dose of SARS-CoV-2 vaccination (85% mRNA) of n=100 LTx and n=40 HTx patients was analysed for S1, S2 and RBD-specific IgG antibodies by Luminex-based multiplex assays. The threshold for positive antibody responses was set separately for each spike domain based on the median MFI + 2σ in an unexposed pre-pandemic control group. Results For all three spike protein domains, HTx patients showed a significantly higher rate of positive IgG responses than the LTx patients (73% vs 43%). The comparison of MFI values for S1-, S2- and RBD-specific IgG further underlines the superior antibody response by HTx patients with higher MFI values for S1 (p = 0.0001, S2 p = 0.008, RBD p < 0.0001). In the LTx cohort, MFI values for S2- (p < 0.0001) as well as for RBD-specific IgG (p < 0.0001) were higher than for S1. The same applies for S2 vs S1 (p < 0.0001) and RBD vs S1 (p = 0.0018) in the HTx cohort. Comparing the MFI of S2 vs RBD, the levels of domain-specific IgG were higher for S2 than RBD in both LTx (p < 0.0001) and HTx patients (p = 0.0914). Conclusion HTx patients exhibit a moderately good IgG response to vaccination while LTx recipients show lower antibody responses. Based on the more efficient antibody production against S2 as opposed to the RBD and especially S1-domain, the S2-specific IgG response should be taken into consideration when evaluating the general immune response and the resulting protection after SARS-CoV-2 vaccination in transplant recipients. Both groups of patients might benefit from booster vaccinations. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3658 | Radiographic and Histopathologic Lessons from COVID-19 Explants Purpose COVID-19 acute respiratory distress syndrome (ARDS) can result in irreversible lung damage. Lung transplant is a viable option for such select patients. Our aim is to describe the radiologic features prior to lung transplant and post transplant explant pathology, in such patients. Methods A single center retrospective chart review was performed of adults who underwent lung transplant for COVID-19 ARDS from 7/1/2020 until 7/31/2021. Demographic data, imaging reports at the time of listing and explant pathology were collected. Results 25 patients were included and none of them had pre-existing lung disease. Chest CT reports obtained at the time of transplant listing and post transplant lung explant reports were reviewed. Most common radiographic and explant features were traction bronchiectasis and NSIP pattern interstitial fibrosis, respectively. Conclusion To our knowledge, this is the largest descriptive report on COVID 19 explants. Though NSIP pattern is the most common finding on explants, only 48% of patients had fibrosis on CT scan prior to listing. Hence, other findings reflective of end stage lung disease such as traction bronchiectasis, GGO's should be considered along with respiratory mechanics while assessing the need for lung transplant for COVID-19 ARDS. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3659 | Single Lung Transplantation for Pulmonary Fibrosis Secondary to COVID-19 Introduction As of April 2021, 78 lung transplants (LTx) were performed for a diagnosis of COVID-19: 50 for COVID-19 ARDS and 28 for pulmonary fibrosis. Bilateral LTx has been recommended as many patients develop significant pulmonary hypertension. Additionally, native lung explants may include cavitary areas of pneumonia, which could serve as a nidus for infection. Single LTx (SLTx) can be considered in patients who have chronic pulmonary fibrosis secondary to COVID-19 with a short window to receive a transplant, or who would otherwise be considered for a single lung. There have been no published cases of a single lung transplant for COVID-19 pulmonary fibrosis. We present a case of a patient with pulmonary fibrosis from COVID-19 who underwent SLTx. Case Report A 70yo male with O+ blood type was hospitalized 8/2020 to 10/2020 with COVID-19 pneumonia, treated with Remdesivir and Tocilizumab. He had hypoxia but never required intubation. His course was complicated by bilateral pneumothoraces requiring chest tubes. He developed pulmonary fibrosis requiring 6 L of oxygen at rest. CT scan of his chest showed multifocal, peripheral prominent ground glass opacities and interlobal septal thickening with traction bronchiectasis. Ventilation-perfusion scan demonstrated 22% perfusion to the left lung and 78% to the right lung. Right heart catheterization showed pulmonary artery pressures of 36/12 mmHg. His pulmonary function test was suggestive of restrictive disease (FEV 0.81 L [30%], FVC 0.96 L [27%], and FEV1/FVC 85%) that had worsened over time. He was presented at multidisciplinary review board with recommendation to list for left SLTx, which was activated August 2021. The patient was admitted in September 2021 and underwent left single lung transplant via left anterolateral thoracotomy, off cardiopulmonary bypass. Total ischemia time was 3:54. Explant pathology showed end stage pulmonary fibrosis. The patient was extubated on postoperative day 1 with an uneventful postoperative course. He was discharged to skilled nursing facility on postoperative day 26 for rehabilitation. Summary SLTxp is safe and feasible for COVID-19 related pulmonary fibrosis in well-selected patients who have a short window to receive a transplant. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3660 | Right Ventricular Free Wall Strain RVFWS as a Predictor of Outcome in Heart Transplantation Patients with COVID-19 Disease Purpose The aim of study was to echocardiographicly evaluate right ventricular function as a predictor of outcome in COVID 19 patients (pts) who underwent heart transplantation using RV strain and speckle tracking. Methods 15 pts (mean age 47, 12 male 3 female) underwent heart transplantation from October 2020 to May 2021. All pts underwent transthoracic echocardiography for the evaluation of RV free wall longitudinal peak systolic strain RVFWSL, TAPSE, RVd1, RVd2, RVd3, FAC, TRVmax, IVC diam and S’. Results All pts were PCR positive for SARSCoV2 and had cough, fever and malaise indicative of COVD19, therefore were also radiological signs of COVID19 pneumonia. Also HS troponin, procalcitonin and CRP were elevated. They were treated with antiviral drugs and immune - based therapy including corticosteroids and convalescent plasma, and received standard triple regimen of calcineurin inhibitors (tacrolimus), antimetabolite (Mycophenolan Mofetil).All echocardiographic measurements were obtained from apical 4-chamber RV with focusing on the lateral wall. RvV free wall longitudinal peak systolic strain (RVFWSL) were significantly reduced during infection compared to post infection time (-15% vs -20) and RV four-chamber strain (RV4CSL) (-11,3% vs 21%). The RV function correlated with recovery time among heart transplant patients which was longer and also correlates significantly with acute cellular rejection in myocardial biopsy (10 patients -66,6% had 2R by ISHLT) . In comparison to 2D measurement (RV diameter 28+/- 35, TAPSE 17+/-22, FAC 34+/-45) we did not observe significant difference during infection and post infection time. Conclusion The study confirms that RV4CSL and RVFWSL are independent predictors of outcome in COVID 19 patients who undergo Heart transplantation. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3661 | Chronic COVID-19 Related Disease Requiring Lung Transplantation with Calcified Cavitary Lesions in Explanted Lungs Introduction Bilateral cavitary lung lesions with calcification in a patient with chronic COVID requiring transplantation are described. Case Report 46-year-old woman presented for lung transplant with respiratory failure due to COVID-19 pneumonia following remdesivir, decadron, tocilizumab and baricitinib therapy. Cavitary upper lobe lung lesions were noted on imaging with negative cultures. She was started on VV ECMO as a bridge to bilateral lung transplant. Explanted lungs were consolidated and fibrotic with bilateral upper lobe calcification surrounding cavitary lesions. Varied microscopic pathology included NSIP pattern of inflammation, and foci of airway centered inflammation with giant cells suggesting chronic hypersensitivity reaction. The calcification was reminiscent of dendriform/metastatic calcification, and involved areas of necrotic/mummified parenchyma. Summary Cavitation as a late stage complication of COVID19 has been described in rare cases and is considered atypical. The constellation of findings in our case, including cavitary lesions with associated dendriform like calcifications are unique and maybe attributable to COVID19 itself +/- exacerbation of underlying chronic lung disease +/- intercurrent infection, or COVID19 related cavitation with superimposed secondary changes due to ECMO treatment. Bilateral lung transplantation has a reasonable short-term prognosis for patients with end stage respiratory failure secondary to COVID19; examination of these native lungs may expand our concept of COVID19 related chronic lung injury patterns. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3662 | Physical Activity After Heart Transplantation: Characteristics, Motifs, Barriers and Influence of COVID-19 Pandemic Purpose After heart transplantation (HTX), regular physical activity (PA) is crucial to counteract transplant-related alterations and improve functional performance. Not much is known about the long-term implementation of PA and potential problems that may occur. The potential influence of COVID-19 pandemic is unknown. Methods Online questionnaire survey: 158 patients (53±14 yrs, 65% male, 8±7 yrs after HTX) were included. Recruitment was carried out via HTX outpatient departments, transplant sport associations, self-aid groups and social media. The questionnaire included 77 to 138 items divided into 6 categories and 3 time points (pre heart failure, after HTX before COVID-19, after HTX during COVID-19). The survey was approved by the local ethics committee. Results 88% reported regular PA after HTX (before COVID-19) and 75% had taken up PA within the first year. Patients stated higher level of PA after HTX, compared to the pre heart failure period (p<0.05). Patients who completed cardiac rehabilitation (70%), started leisure-time PA significantly earlier (p<0.05) and with higher frequency (p<0.05). Figure 1 shows the most important motifs/barriers for regular PA and changes over the reported period. Satisfaction with sports facilities was moderate and 39% complained about the need for improvement (e.g. exercise education). 61% performed exercise training without a professional supervision. Exercise monitoring was mostly done using heart rate respond (52%), but frequently no monitoring was used (32%). During COVID-19, patients were more dissatisfied with their level of regular PA (p<0.01) or physical condition (p<0.05) and emphasized the beneficial effect of PA on their mental balance. Conclusion After HTX, most patients try to integrate regular PA in their leisure-time behavior, but complain about a lack of detailed exercise education and appropriate sports facilities. Participation in a cardiac rehabilitation after HTX may have positive long-term impact on PA levels. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3663 | Lung Transplant Recipients with SARS-CoV-2 Infection Induce Circulating Exosomes with SARS-CoV-2 Spike Protein S2 Which Are Immunogenic in Mice Purpose Exosomes are nanosized vesicles released by cells into body fluids. We have demonstrated the presence of circulating exosomes containing viral antigens in lung transplant recipients (LTxR) undergoing rejection. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), an important risk factor for LTxR undergoing immunosuppression. Our goal is to determine whether exosomes with SARS-CoV-2 spike protein are induced in LTxR with SARS-CoV-2 infection and exosomes are immunogenic in mice, inducing immune responses to the spike protein Methods We analyzed 67 patients with SARS-CoV-2 infection for the induction of circulating exosomes with SARS-CoV-2 spike protein. Exosomes were isolated from plasma by an exosome precipitation protocol followed by 0.2 micron filtration and size determination by NanoSight300. Exosomes were first analyzed by western blot with specific antibodies to SARS-CoV-2 spike and its nucleoprotein. Eluted proteins from the gel were analyzed by mass spectrometry. Exosomes were subjected to transmission electron microscopy (TEM) to detect spike and nucleocapsid antigens. To determine the immunogenicity of isolated exosomes, C57BL/6 mice were immunized with exosomes carrying SARS-CoV-2 spike protein. Results Exosomes from SARS-CoV-2 infected LTxR expressed SARS-CoV-2 spike protein S2 and increased levels of RNA related to SARS-CoV-2. Peptides specific for SARS-CoV-2 spike protein in exosomes were confirmed by mass spectroscopy. TEM also revealed the expression of spike protein and nucleocapsid antigens on the exosome surface. Mice immunized with exosomes carrying the spike protein, developed antibodies to SARS-CoV-2 spike antigens. Severe inflammation and lesions were also demonstrated in the lungs of mice immunized with exosomes carrying SARS-CoV-2 spike protein. Splenic lymphocytes from mice immunized with exosomes carrying SARS-CoV-2 spike antigen also demonstrated increased frequency of T-cells which are spike protein antigen specific and secreting IFN-γ and TNF-α . Conclusion SARS-CoV-2 infected LTxR induce circulating exosomes with spike protein and nucleic acids related to SARS-CoV-2. Since the induced exosomes are highly immunogenic, we propose that the exosomes induced by SARS-CoV-2 will have immunological consequences relevant to the COVID19 disease process. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3664 | Airway Complications After Lung Transplant for Post Coronaviral Disease Acute Respiratory Distress Syndrome (ARDS) Related End Stage Lung Disease: Single Centre Experience Purpose Severe COVID-19 ARDS related end stage lung fibrosis with irreversible changes is a newer indication for lung transplantation with acceptable survival rate. Airway complication post lung transplant is a major source of morbidity and mortality with incidence as high as 25 to 49 percent. Patients with end stage COVID-19 fibrosis are likely to be clinically deconditioned with long duration of extracorporeal oxygenator (ECMO) support, high burden of sepsis and prolonged respiratory support which may affect the airways post lung transplantation. Methods This is a retrospective observational study after obtaining institutional ethical clearance. We reviewed electronic medical data of patients who underwent lung transplantation for post COVID-19 ARDS related fibrosis. We evaluated the incidence and type of airway complications and the various therapeutic interventions applied for its management. Results Between May 2020 and September 2021 our centre performed 23 bilateral lung transplants for end stage COVID-19 ARDS related fibrosis. 22 patients were on ECMO support with mean duration of 50.9 days before transplantation. All patients underwent lung transplantation with central Veno-Arterial ECMO support with mean organ ischaemia time of 360±154 minutes. The incidence of airway complication in our study group was 56%. We observed anastomotic narrowing in 3(13%), distal airway narrowing in 4(17%) and sloughing/coating of anastomotic site in 5(22%) patients. Nonspecific inflammatory polypi around the bronchial anastomotic site were noticed in 4(17%) and mild airway anastomotic dehiscence in 2 subjects. 8(34%) patients required serial bronchoscopy and balloon dilatation; 2 among them mandated additional cautery usage. 2 cases underwent polypectomy, further 4 subjects needed bronchial stent placement. 5 (21%) recipients were discharged with Tracheostomy while rest were successfully decannulated in the ward. Conclusion We observed a high incidence of airway complications in post lung transplant for COVID-19 ARDS related fibrosis. Early detection, timely management and serial follow up is of paramount importance in this subset of patients. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3665 | Severe Isolated Cardiomyopathy Requiring Heart Transplant Following COVID-19 Infection and Subsequent Vaccination Introduction Cardiomyopathy is a known complication associated with COVID-19, and 7% of all COVID-19 related deaths are thought to be due to myocarditis. There is also growing evidence for COVID-19 vaccine-related myocarditis. We present the first case of a patient with severe isolated cardiomyopathy requiring heart transplant after both COVID-19 infection and vaccination. Case Report A 58-year-old male with no prior medical history was diagnosed with COVID-19 infection in December 2020 without hospitalization. He experienced declining symptoms over the next 7 months and completed COVID-19 vaccination in July. On 8/10/2021, he presented to the emergency room with worsening exertional dyspnea and orthopnea. Initial labs revealed elevated NT-proBNP (1,701 pg/mL) and high-sensitivity cardiac troponin-T (45 ng/L). Transthoracic echocardiography revealed reduced left ventricular (LV) ejection fraction at 15% and LV end-diastolic diameter at 5.6 cm. Coronaries were clear. Cardiac MRI (cMR) is depicted in Figure 1. He was managed with an Impella device and dobutamine but failed weaning from this cardiac support. He was listed for transplant as UNOS Status 2 and underwent successful OHT on 9/19/2021. Summary Acute myocardial injury is known to be a frequent complication during the COVID-19 course, but it is not known to require advanced therapies. There is only one other case from France that describes a patient bridged with temporary mechanical support to OHT following COVID-19 induced cardiomyopathy. In both cases, cMR revealed similar late gadolinium enhancement (LGE) patterns. The cases differ as our patient experienced Long COVID symptoms over 8 months after diagnosis and was vaccinated while the French report describes a patient who was diagnosed with COVID-19, experienced end-stage heart failure and underwent transplant all within 11 days. This case contributes to the lacunae in data in the era of COVID-19 and its vaccines. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3666 | Successful Percutaneous Mechanical Suction Thrombectomy of Extracorporeal Filtration System Following Bilateral Lung Transplantation Secondary to COVID-Pneumonia Introduction COVID infections show increased risk of thromboembolic events. We report a case of a 43 year old male with acute Covid-19 pneumonia necessitating veno-venous ECMO and RVAD support as bridge to pulmonary transplantation. At transplant, he had thrombus along his extra-corporeal pulmonary artery cannula necessitating percutaneous mechanical thrombectomy. Case Report The patient presented as a transfer to our institution with COVID-19 related ARDS in refractory respiratory failure with multiple bronchopleural fistulas. Shortly after admission, veno-venous ECMO was initiated and over time was fully ECMO dependent due to extensive tissue destruction with essentially no functional lung tissue. He was converted to right internal jugular-left subclavian vein ECMO-RVAD configuration while assessing for transplantation. After 135 days of support, a suitable donor was identified and was taken for bilateral lung transplantation with ECMO/RVAD support. This was complicated by a frozen chest, massive transfusion, and primary graft dysfunction necessitating postoperative maintenance of circulatory support. Intraoperatively, a large thrombus burden was found along the pulmonary artery outflow cannula. His chest was left open at that time while his graft recovered. Three days later, a percutaneous suction thrombectomy device was inserted through his right femoral vein and under TEE guidance, he underwent suction thrombectomy of the pulmonary artery cannula clot burden (Figure 1). He was decannulated and underwent chest closure thereafter. He was anticoagulated post-operatively and has not had any further thromboembolic events. Summary Acute COVID-19 infection leads to a known increased risk of thromboembolic phenomena. We present an interesting approach to removal of ECMO-cannula associated thrombus in severe SARS-CoV-2 infection necessitating bilateral lung transplantation. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3667 | Independent and Combined Effects of Age and COVID on Patient Outcomes Purpose To evaluate the independent effect and interactive effect of age and positive Covid-19 status on patient survival and number of days spent on ECMO. Methods Single center data was gathered for patient's currently receiving ECMO treatment. The main effect and interaction effect of patients’ age and COVID status was evaluated to investigate the impact of these factors on patient outcomes of discharged deceased and days on ECMO. A logistic regression model of 204 patients was used to evaluate the outcome of discharged deceased, and a Poisson regression model of 129 patients was used to evaluate the outcome of patient days spent on ECMO. Results In the logistic regression on discharged deceased adjusting for COVID status (n=204), age was associated with higher odds of death (OR=1.05 per year older, CI95 1.03-1.07). COVID was strongly associated with mortality (OR=4.81, CI95 2.46-9.43). Incorporating an interaction between age and COVID status, being discharged deceased was significantly associated with older age but COVID status and the interaction between COVID and age were not significant predictors of mortality. In the Poisson regression on days on ECMO (n=129), main effects of both age and COVID were noted. In the test of the interaction of age by COVID status, the interaction was also significant as were both main effects. Conclusion Both age and positive COVID status were found to be independent risk factors for increased patient mortality, however only age was associated with increased patient mortality when interaction between age and COVID was incorporated. Conversely, older patients with and without COVID exhibited decreased days on ECMO, whereas COVID was associated with a significant increase in days on ECMO. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3668 | Global and Country-Level Impact of COVID-19 on Heart Transplant Volumes Purpose Shifting healthcare resources to deal with the COVID-19 has hampered heart transplant programs around the world, making orthotopic heart transplant (OHT) less feasible. We aim to describe the global impact of COVID-19 on OHT volumes one year after the pandemic. Methods Using data from the Global Observatory on Donation and Transplantation (GODT), the world's most comprehensive source of data on organ donation and transplantation, we determined the number of OHT procedures performed in the years 2019 (pre-COVID-19 era) and 2020 (COVID-19 era). Countries with reported data on OHT volumes in both years (n=51 countries) were included. OHT volumes were reported for each country per million population (PMP), and change in the COVID-19 era was expressed as a percentage of the pre-COVID-19 rates of OHT PMP. Results Among countries included in this analysis, the number of OHT decreased by 9.3% during the COVID-19 era (a decrease from 1.82 to 1.65 OHT PMP). However, significant variability existed among included countries, such that 76.5% (39/51) of countries experienced a reduction in OHT volumes during the COVID-19 era (median OHT of 2.56 PMP in 2019 vs. 1.84 in 2020, median difference -0.53 OHT PMP, IQR [-0.83, -0.2], p<0.001) while the rest experienced an increase in OHT volumes (median OHT of 4.1 PMP in 2019 vs. 5 in 2020, median difference 0.47 OHT PMP, IQR [0.12, 0.95], p=0.002). Figure.1 features changes in OHT volumes after COVID-19 around the world. Conclusion In a representative sample of countries around the world, OHT volumes decreased significantly during the early phase of COVID-19 pandemic in most, but not all countries around the world. Understanding the causes leading to heterogeneity in change in OHT volumes during COVID-19 pandemic may help uncover essential strategies to maintain organ transplantation activities during similar circumstances in the future. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3669 | TTV Load is Associated with SARS-CoV-2 Vaccination Response in Lung Transplant Recipients Purpose Although the currently approved COVID-19 vaccines are highly effective, SARS-CoV-2-specific immune responses are diminished in lung transplant recipients (LTR), probably due to immunosuppression (IS). There is currently no marker of IS that can be used to predict vaccination responses. Here, we study if torque tenovirus (TTV) can be used as a predictive marker. Methods The humoral response to the mRNA-1273 vaccine was assessed in 103 LTR, who were vaccinated 4 to 237 months after Lung transplantation. Spike (S)-specific IgG levels were measured at baseline, 28 days after first, and 28 days after the second vaccination. TTV loads were determined by RT-PCR and Pearson's correlation coefficient was calculated to correlate serological responses to TTV load. Results Humoral responses to the vaccine COVID-19 vaccination were found in 41/103 (40%) LTR at 28 days after the second vaccination. 62 /103 (60%) had no detectable antibodies. TTV loads at baseline correlated with S-specific antibodies and the percentage of responders (=<0.001) (Fig 1). TTV loads also strongly correlated with the time since transplantation, indicating that participants with lower TTV loads were longer after transplantation. Conclusion This study shows an association between baseline TTV load and mRNA-1273-induced S-specific antibodies. If the TTV load is indeed a predictor of vaccination responses, this can be used in the future as a potential guidance for optimizing vaccination regimens. Therefore, we recommend that TTV load measurements are included in further vaccination efficacy studies in immunocompromised cohorts. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3670 | From 13% to 60%: A Rare Case of Multisystem Inflammatory Syndrome in Adults 4 Weeks Following COVID-19 Infection Introduction Multisystem inflammatory syndrome in adults (MIS-A) is a rare but serious entity implicated with COVID-19 infection. Improved diagnosis and treatment of MIS-A may mitigate morbidity and mortality attributed to COVID-19 infection. Case Report Our patient is a 24-year-old male with no known past medical history except for COVID-19 infection diagnosed 4 weeks prior. He presented with a 5-day history of intractable nausea, vomiting, and abdominal pain. He was febrile. COVID-19 test was negative. The patient became hypotensive, tachycardic and was aggressively resuscitated (5L crystalloid) with no improvement. He was transferred to ICU, intubated for worsening acute hypoxic respiratory failure, and started on vasopressors. TTE showed EF of 13% with severe global LV hypokinesis and RV enlargement with severe global hypokinesis. He underwent urgent coronary angiogram which showed normal coronaries. His clinical course was consistent with the working definition of MIS-A as specified by the CDC. As the patient was in cardiogenic shock with severe biventricular dysfunction, left femoral Impella CP and right femoral Impella RP were placed. Given his severe hemodynamic compromise leading to persistent shock and multiorgan failure, he was eventually placed on venoarterial ECMO. The patient was being treated with methylprednisolone, IVIg and anakinra. Over the following days, he continued to improve, and his vasopressors were weaned off. His Impella CP was successfully removed with stable LV pulsatility on arterial line. His LV function improved on TTE and the patient was decannulated 5 days after initiation of VA ECMO. TEE done 6 days after initial echocardiogram showed LVEF of 60% and normal RV systolic function. The patient was extubated and continued to improve clinically. Summary MIS-A is a serious hyperinflammatory condition that presents with multiorgan dysfunction approximately 4 weeks after onset of COVID-19 infection. Aggressive supportive care in the ICU, utilization of advanced heart failure devices, and immunomodulatory therapeutics should be utilized during management. More studies are needed to elaborate on treatment modalities and clinical predictors. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3671 | COVID-19 in LVAD Patients Not Associated with Increased Risk of Thrombotic Complications: A Single-Center Experience Purpose The COVID-19 pandemic continues to afflict millions worldwide. Scientific knowledge about the virus is expanding including the thrombosis risk associated with COVID-19 infection. However, this data in end-stage heart failure patients requiring mechanical circulatory support is limited. Thus we examined the incidence of thrombotic complications in COVID-19 infected LVAD patients. Methods We identified durable LVAD patients infected with COVID-19 from January 2020 to July 2021. We examined anticoagulation regimens and laboratory monitoring parameters that were used. Evidence of thromboembolic phenomena including stroke, venous or arterial and pump thrombosis were evaluated by clinical, radiographic and laboratory assessment. Results Of the 146 LVAD patients followed at our institution, 21 (14%) were infected with COVID-19. Median age was 69 years (IQR 58-73), 18 (86%) were men and 12 (57%) had non-ischemic cardiomyopathy. In our cohort, 3 (14%) had HeartWare VAD, 9 (43%) HeartMate 2 LVAD and 9 (43%) HeartMate 3 LVAD. Eighteen (86%) were on warfarin with a median international normalized ratio (INR) of 2 (IQR 1.6-2.9) at the time of COVID-19 diagnosis. Reasons for holding antithrombotic therapy included a history of gastrointestinal and intracranial hemorrhage. Fourteen (66.7%) patients required admission for COVID-19 infection. Two (14%) were not on anticoagulation and had an INR of 1.1 and 1.6 on admission. Patients on anticoagulation had a median INR of 2.4 (IQR 1.9-2.7) during hospitalization. Notably, there was no clinical, radiographic or laboratory evidence of thrombotic complications, including stroke, pump thrombosis, DVT, or arterial thrombosis. Two (10%) patients died due to septic shock and hypoxic respiratory failure resulting in cardiopulmonary arrest. Conclusion Although COVID-19 is associated with increased thrombogenicity, there was no evidence of thrombosis in our 21 LVAD patients. Regardless of the patients’ anticoagulation status or INR, patients did not experience thrombotic events despite a theoretically heightened risk during acute COVID-19 infection. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3672 | CARE Score on Chest Radiograph at Diagnosis Predicts Early and Late Outcomes Among Lung Transplant Patients with COVID-19 Purpose To assess the ability of an objective radiographic scoring system to predict outcomes among lung transplant (LT) patients with Coronavirus disease 2019 (COVID-19). Methods We included all LT patients diagnosed with COVID-19 during a one-year period (March 2020 to Feb 2021; n=54; median age: 60, 20-73 years; M:F 37:17) in our program. Patient characteristics and laboratory values during the acute illness were reviewed. Chest radiographs at time of COVID-19 diagnosis were scored by extent of ground-glass opacity and consolidation using the CARE score (0-18 for each lung). The CARE score was calculated using only the allograft in single LT and the average of both lungs in bilateral LT. Primary outcome was six-month survival after COVID-19. Hospital complications and one-month survival were secondary outcomes. Results A minority of patients had a clear allograft (CARE=0, n=12, 22.2%) at presentation. The median score was 2 (interquartile range 0.5-4.625), indicating mild abnormalities. Demographics, underlying diagnosis, comorbidities, symptoms, and spirometry changes were not associated with the baseline CARE score. Baseline CARE score >5 was strongly associated with development of respiratory failure (91.7% vs 35.7%; OR, 95% CI: 19.8, 2.3-168.7; p=0.001), ICU admission (p<0.001), need for ventilator support (p<0.001), and one-month mortality (41.7% vs 2.4%; OR, 95% CI: 29.4, 2.96-333.3; p=0.001). Overall six-month survival was 81.5%. The CARE score was significantly higher among non-survivors (7.7±4.1 vs 2.2±2.7; p=0.002). Patients with a CARE score>5 at diagnosis were significantly less likely to survive at six-month follow-up (41.7%.vs 92.3%; p<0.001). The CARE score had an excellent area under the curve (86.8%, 74.4%-99.2%; p<0.001) on the Receiver operating characteristic curve for predicting six-month survival after COVID-19. Conclusion The CARE score at time of COVID-19 diagnosis provides useful prognostic information among patients with LT. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3673 | Impact of COVID-19 Vaccination After Orthotopic Heart Transplantation Purpose The effect of COVID-19 vaccination in orthotopic heart transplant (OHT) patients is unknown. After OHT, patients are increased risk of COVID infection and hospitalization. Methods We retrospectively analyzed 119 patients who underwent OHT between 2017 and 2021. Eleven patients were excluded who died prior to the COVID outbreak in the United States. Results The mean age was 51 years (IQR 26). The known vaccination rate (partial or complete) was 83%. The overall infection rate was 14% (17 COVID cases were identified.) Five patients were infected prior to the availability of the COVID vaccine. Of the remaining 2 (16%) and 5 (42%) were in vaccinated and unvaccinated patients respectively. The hospitalization rate due to COVID infection or COVID-related complications such as supplemental oxygen use was 29%. All hospitalized subjects underwent changes in their antirejection therapies, and half required oxygen supplementation therapy at discharge. No COVID-related deaths were identified. There were 2 partially/fully vaccinated patients at the time of COVID infection. One patient had mild symptoms and did not require hospitalization while the other patient was asymptomatic. Conclusion Hospitalization rates were markedly higher in the OHT cohort compared to Kentucky state data (29% vs 4%.) Multiple factors contribute to this finding. Patients with OHT have more co-morbidities and after OHT and immunosuppressant therapy blunts host response to infection placing these patients at higher risk of complications. There was a higher vaccination rate in our OHT cohort compared to Kentucky state data (83% vs 61%). Breakthrough COVID infection was found in only 4% of OHT patients strongly supporting the efficacy of the vaccination in this immunosuppressant subgroup. While there were no COVID related deaths in our cohort, downstream complications related to immunosuppression changes and organ rejection detection require long term follow up. The vaccine has proved highly efficacious in this group and should be implemented up front, prior to transplantation. We suggest pre-transplant COVID-19 vaccination should become mandatory in patients being evaluated for OHT. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3674 | Late Cytomegalovirus Primoinfection in a Heart Transplant Recipient After COVID-19 Vaccine Introduction Cytomegalovirus [CMV] is a frequent infection in solid organ transplant recipients and the mRNA COVID-19 vaccine has been associated with transient lymphopenia, which could be a risk factor to consider for CMV replication. Case Report A 51-year-old man with arterial hypertension and a history of repaired complex congenital heart disease, which required a heart transplant [HT] in 2019. He had a high risk CMV missmatch (D+/R-). Routine HT follow up tests after the first year were normal, with neither signs of rejection nor allograft vascular disease. His immunosuppressive treatment consisted in Tacrolimus 5 mg once a day, Mycophelonate 500 mg twice a day, and Prednisone 5 mg a day. 77 weeks after his heart transplant, two doses of mRNA COVID-19 vaccine were inoculated separated by 28 days. After 4 days of the second dose, he developed fever, diarrhea, and general malaise. The physical findings were abdominal pain, slight hepatomegaly and several painful gum lesions. Laboratory tests showed severe lymphopenia; and elevated C-reactive protein. CMV by polymerase chain reaction was tested positive with 228.356 copies/ml. The decision was to admit him and to initiate intravenous ganciclovir 5 mg/kg twice a day and to reduce the immunosuppressive treatment. He completed a course of 15 days with ganciclovir, and then continued with valganciclovir 900 mg twice a day. Early after ganciclovir start, clinical manifestations gradually disappeared. Due to persistent lymphopenia, mycophenolate was switched to everolimus. After 60 days of antiviral treatment, CMV loading was below detection range (Image 1). Summary The probability of favoring CMV replicability after mRNA COVID-19 vaccine has not been yet described. We here present a case of CMV primoinfection closely related in time with a full mRNA COVID-19 vaccine administration. We hypothesize that lymphopenia and a high risk CMV could be factors to consider at the time of mRNA COVID-19 vaccine administration. A close CMV monitoring should be advised in this scenario. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3675 | SARS-CoV-2 Vaccine Response in Lung Transplant Recipients: A French Multicenter Study Purpose Many scientific societies recommend SARS‐CoV‐2 vaccination for solid-organ transplant recipients. The immunogenicity of two or three vaccine doses in lung transplant (LTx) recipients is unclear. The aim of this study was to evaluate the humoral response to the vaccine in LTx and heart-lung transplant (HLTx) recipients. Methods We conducted a prospective study of LTx and HLTx recipients at seven centers in France. Anti-spike-protein antibody titers after two or three SARS‐CoV‐2 vaccine injections were measured. Results We studied 2186 patients (1091 [51%] males) with a median age of 49 [45-55] years. Double LTx was performed in 1792 (82%) patients. The main reasons for LTx were chronic obstructive pulmonary disease (n=656, 30%), fibrosis (n=459, 21%), and cystic fibrosis (n=350, 16 %). Median time from LTx to vaccination was 59 [29-108] months and mean time from the last vaccine dose to serological testing was 3 months [1.5-3.8]. We used WHO definitions to classify antibody titers as negative (<. 30 BAU/mL), suboptimal (30-260 BAU/mL), or protective (> 260 BAU/mL). Of the first 1081 patients, 270 (25%) were partially vaccinated and 649 (60%) fully vaccinated (three doses or history of COVID-19 then two doses); Among these patients,133 (12%) were infected by covid. Of the 649 fully vaccinated patients, 461 (71%), 84 (13%), and 97 (15%) had negative, suboptimal, and protective antibody titers, respectively. The proportion of patients with protective titers was 8% vs. 18% in patients vaccinated within 5 years vs. 5 or more years after LTx, respectively. Among covid-infected patients, 48% developed a protective rate, whether fully or partially vaccinated. Conclusion LTx recipients usually fail to develop protective antibody titers in response to SARS-CoV-2 vaccination. Once further data are collected, we will seek to identify risk factors for a poor antibody response. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3676 | Characterization of Lung Transplant COVID-19+ Patients and Mortality Outcomes Purpose The aim of this study is to report the characteristic and mortality outcomes of lung transplant patients that contracted COVID19. Methods A retrospective chart review was conducted of lung transplant recipients who tested positive for COVID19 from 6/1/2020 to 9/1/2021. Results Forty-five patients were included for mortality incidence review with 2 patients who were admitted to outside facilities during their COVID diagnosis with limited treatment data. Mortality incidence was 15.5% with cohort mean age of 62 (±11.7). Median time from transplant to infection was 1281 days (223-5800). Five patients required O2 and n=5 were intubated with 80% mortality (n=4) among those intubated. Baseline demographics of age, gender, indication for transplant or race were not statistically different among patients that died vs those that survived. Vaccinations (2 doses) prior to infection were evident in n=35 (77.8%) of the patients. Maintenance immunosuppressants and covid therapies (table 1) did not have an associated difference in survival from infection. A significant association with mortality was found from the time of reported symptoms to triage or hospitalization in those that survived vs died, 3.3 vs 9.4 days (p=0.003). Conclusion This is one of the largest cohorts reporting lung transplant recipients who contracted COVID19, and despite lungs being the organ directly affected by COVID19, mortality rates are comparable to rates reported in other solid organ transplants. Time to triage from symptom onset to clinic management or hospital admission for COVID appears to be associated with improved mortality rates. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3677 | Analysis Paralysis: Transition to HeartMate 3 Left Ventricular Assist Device Despite Multiple Complications from COVID-19 Introduction We present a case of a 39 year old male with nonischemic cardiomyopathy who was successfully bridged to HeartMate3 Left Ventricular Assist Device (LVAD) despite multiple life threatening complications secondary to Covid-19. Case Report 39-year-old male with past medical history notable for tobacco abuse and recently diagnosed non-ischemic cardiomyopathy presented to our institution with NYHA Class IV symptoms and was found to be in cardiogenic shock. On admission Covid-19 PCR was negative. He initially responded to the initiation of inotropic support and aggressive diuresis with normalization of his end-organ function and improvement in his symptoms over three days. He suddenly experienced rapid hemodynamic decline necessitating escalation of inotropic and mechanical circulatory support with VA ECMO and Impella 5.5. On that day, his wife felt unwell and was found to be positive for Covid-19. The patient's Covid-19 PCR was repeated and also positive. He underwent treatment with Regeneron. His hospital course was further complicated by multiple sequelae of Covid-19 including pneumonia, acute renal failure necessitating hemodialysis (HD), and Guillain Barre Syndrome (GBS) presenting with bilateral ascending paralysis extending to his hip flexors, improved with intravenous immune globulin (IVIG) therapy. Over a period of two weeks, he demonstrated improvement and was weaned from VA ECMO to Impella 5.5. Unfortunately, he was unable to tolerate weaning the Impella 5.5. He was aggressively rehabilitated. After extensive multidisciplinary discussion, LVAD implantation was recommended to the patient. Following insertion of a HeartMate3 LVAD, the patient demonstrated renal recovery and ongoing improvement in physical ability. He was discharged to an acute rehabilitation facility and was subsequently discharged home. He will be monitored for listing for cardiac transplantation pending abstinence from tobacco use. Summary Covid-19 can present with multiple life threatening complications that can add novel challenges to the management of patients with stage D cardiomyopathy. Despite complications of acute renal failure and paralysis secondary to GBS from Covid-19, our patient was successfully supported with temporary mechanical circulatory support, aggressively rehabilitated, and transitioned to a durable HeartMate 3 LVAD. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3678 | A Comparison of Short-Term Morbidity and Mortality Among Inpatient Lung Transplant Recipients Transplanted for COVID-19 and Other Restrictive Lung Diseases Purpose Patients with respiratory failure (RF) who are hospitalized at the time of lung transplant (LTx) have higher post-LTx morbidity and mortality than those who are well enough to remain at home. Complications may be even worse in patients transplanted for COVID-19 (C19), as they are commonly critically ill having endured prolonged mechanical ventilation, ECMO support, myopathy, malnutrition, and superimposed infections. In a retrospective cohort study, we compared inpatient lung transplant recipients (LTxRs) transplanted for C19 vs. other underlying restrictive lung diseases (RLDs) Methods After IRB approval, patients who underwent inpatient LTx between 1/1/2014 and 8/31/2021 were categorized by indication: C19 or RLD. We excluded LTxRs <18 years old, a primary indication for LTx other than UNOS disease group D, and redo LTx. Primary outcomes were postoperative morbidity and 90-day survival. Results Out of 163 inpatient LTxRs, 141 met inclusion criteria: 11 (7.8%) with C19 and 130 (92.2%) with RLD. LTxRs with C19 were younger, had a longer pre-LTx hospital stay, and more likely needed pre-LTx mechanical ventilation and ECMO support. LTxRs with C19 were also more likely to have severe adhesions intraoperatively and their chest was more commonly left open after LTx due to a perceived risk of ongoing bleeding. In addition, LTxRs with C19 had a higher prevalence of PGD3 at 72 hours and longer post-LTx hospital stays and trended toward longer post-LTx mechanical ventilation and need for inpatient rehabilitation. The 2 groups had similar 90-day survival (C19, 100% vs. RLD, 95.4%, p=0.472), however, LTxRs with C19 had a higher incidence of acute cellular rejection and DSA production (>2,000 MFI) within 6 months of transplant. Conclusion LTxRs with C19 are typically sicker and have more post-LTx complications than LTxRs with RLD hospitalized at the time of LTx. However, 90-day survival is comparable and high in both groups. Long-term follow-up is needed. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3679 | Immune Response in Heart Transplant Patients Following COVID-19 Vaccination Purpose Previous studies have described poor outcomes in heart transplant patients who develop COVID-19 infection. Therefore, we sought to characterize a single center's experience with heart transplant patient outcomes during the COVID-19 pandemic and the recent role of vaccination in mitigating the risk of mortality. Methods From a single center, we identified all orthotopic heart transplant patients alive at the beginning of the COVID-19 pandemic in March 2020. All patients were followed from the start of the pandemic until their most recent follow up or death. Baseline comorbidities and immediate outcomes data were obtained from the Society for Thoracic Surgery (STS) Adult Cardiac Surgery Database (ACSD). Multiple logistic regression analyzed the association between vaccination status, baseline covariates, and other standard STS outcome measures. Non-parametric tests were used to compare different subgroups. Results We included 153 patients, of which 20.9% developed COVID-19 infection (32/153) with 40.6% (13/32) requiring hospitalization and 15.6% of those patients (5/32) dying as a direct result of COVID-19 pneumonia. Kaplan-Meier survival analysis revealed that unvaccinated patients had a significantly higher rate of all-cause mortality as compared to those patients that were fully vaccinated despite similar baseline characteristics (p < 0.001). Patients with previous COVID-19 infection in addition to vaccination had significantly higher IgG titers as compared to those only vaccinated (6568.50 AU/mL vs. 58.05 AU/mL, p = 0.002). Conclusion Immunization against COVID-19 is associated with a significant reduction in the mortality of heart transplant patients. IgG titers were variable among heart transplant patients who received the vaccine with the highest titers seen in those patients with a personal history of COVID-19. The implications of IgG levels are still unknown. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3680 | Development of De Novo Donor Specific Antibodies Following COVID-19 Vaccination in Cardiac Transplant Purpose Some transplant patients mount an insufficient response to standard COVID-19 vaccine (COVAX) dosing and a booster dose has now been approved. Vaccination carries the theoretical risk of stimulating antibody production to the donor. There are no prior studies surveying de novo donor specific HLA antibodies (dnDSA) after COVAX. HLA-DQ is the most common dnDSA post cardiac transplant and is associated with worse outcomes. We reviewed the development of dnDSA to HLA-DQ in cardiac transplant patients after COVAX. Methods DSA testing (luminex single antigen bead) was performed routinely at the time of surveillance endomyocardial biopsy. We retrospectively recorded any dnDSA to HLA-DQ with MFI >1000 after COVAX. We further identified a historical cohort (pre vaccination) of 32 patients who had DSA testing a minimum of 5 months after transplant. Results 32 adult patients completed COVAX (16 Pfizer-BioNTech, 8 Moderna, 8 Johnson and Johnson) 3-79 mths after transplantation. 16 patients had DSA testing 1-5 mths post COVAX (4-84 mths post transplant) (Table 1). Three patients (18.8 %) demonstrated dnDSA to HLA-DQ (MFI 6360-25,824) 10-20 weeks post COVAX and all had episodes of high grade acute cellular rejection. One additional patient had rejection post COVAX without dnDSA. All 3 patients with dnDSA had robust response to the vaccine with antibodies to spike protein RBD of > 200 U/ml (Elecsys®). Eight vaccinated patients without dnDSA had anti-RBD testing, half had titres > 200 U/ml. In the historical pre COVAX cohort, 3 patients (9 %) demonstrated dnDSA (2022-25480 MFI), one of these had cellular rejection and one developed antibody mediated rejection. Conclusion One fifth of cardiac transplant recipients developed dnDSA in the weeks following COVAX, all associated with rejection. While no definitive conclusions may be drawn, we believe these data suggest the need for immunological surveillance after COVAX. This may be even more important after a booster dose. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3681 | COVID Infection in Heart Transplant Recipients: Experiences from an Epicenter Purpose Heart transplant (HT) recipients are at significant risk from Covid-19 infection due to immunosuppression and potential effects on graft function. Currently no standard care management strategy exists for this population. We sought to describe our experiences as a single center caring for HT recipients with Covid-19 infection. Methods Retrospective chart review of 250 adult HT recipients followed at the University of Southern California identified 46 individuals with PCR-proven Covid-19 infection between March 1st, 2020 and October 1st, 2021. Herein, we report on their baseline clinical characteristics, serial echocardiographic parameters, laboratory values and pharmacologic treatment regimens. Results 46 HT patients were identified with Covid-19 infection. Patients were more likely to be male (74%), with a mean age of 52.0 years old, and average BMI of 28.71. The most common indications for HT included NICM (54%) and ICM (22%), and comorbidities included HTN (59%), HLD (59%), DM (39%), and CAD (26%). Over a third of patients (37%) had a history of smoking, and 7 patients (15%) were vaccinated against Covid-19. Patients were on average 6.53 (1.1-9.0) years post-transplant, and on three 3 classes of immunosuppressive medications (89%). The most common presenting symptoms were fever (24%), dyspnea (33%), hypoxic respiratory failure (26%), and GI symptoms (20%). Only 8 patients (17%) had evidence of graft injury with mean donor-derived cell free DNA levels of 0.41 (NL <0.12). Mean EF was 60.7% pre- and 59.0% post-infection. The most common treatment was supportive therapy (39%), followed by monoclonal antibody therapy (28%), steroids (24%; dexamethasone or solumedrol) and antibiotics (24%). Reduction in antimetabolites (33%), calcineurin inhibitors (15%), and prednisone (15%) was common. Half of the patients were admitted to the hospital with 11% requiring ICU level of care, and half were managed as outpatients. Only 4 patients died (1 from non-covid related illness 6 months post-infection) yielding a 91% overall survival rate. Conclusion In a single-center experience over 18 months, 46 HT patients had proven Covid-19 infection. Overall survival was 91% with mainstays of treatment focusing on supportive care and monoclonal antibody therapy. Further research is needed to clarify optimal treatment strategies in HT patients with Covid-19 infection. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3682 | The Effect of COVID-19 Infection on Transplant Function and Development of CLAD in Lung Transplant Patients: A Multicenter Experience Purpose Concerns have been raised on the impact of the coronavirus disease (COVID-19) on lung transplant (LTx) patients. The aim of this study was to evaluate the effect on the clinical course and transplant function pre- and post-COVID-19 infection in LTx patients. Methods Data were retrospectively collected from adult LTx patients with a proven COVID-19 infection from three Dutch transplant centres, between February 2020 and September 2021. Spirometry results were collected pre-COVID-19 infection and within 3 and 6 months post-COVID-19 infection. Results A total of 59 LTx patients had been tested positive for COVID-19. The median age was 58 years (IQR 49-66), 64% was male and median time since transplantation was 5 years (IQR 2-11). Thirty-three patients (56%) were hospitalized, 30 (51%) were in need for supplemental oxygen therapy, 17 (29%) were admitted to the intensive care unit (ICU) and 13 (22%) required invasive mechanical ventilation. Thirteen patients died (22%), 10 in ICU (77%), 3 (23%) on general wards. Post-COVID-19 spirometry results were available in 45 (76%) patients within three months post-infection and in 34 (58%) 6 months post-infection. Spirometry results and the prevalence of chronic lung allograft dysfunction (CLAD) are shown in Table 1. CLAD pre-COVID-19 was not associated with higher mortality (12% vs 10%, p = 0.162). Conclusion In LTx patients COVID-19 infection results in high hospitalization and mortality rate. FVC and FEV1 was declined three months after infection and gradually improved at 6 months post-COVID-19 infection. However, FVC remained significantly lower after 6 months, demonstrating a more restrictive pattern. The prevalence of CLAD did not change after COVID-19 infection. Further follow-up is required to obtain more detailed information about CLAD. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3683 | Autoantibodies and Severity of COVID-19 in Lung Transplant Recipients Purpose COVID-19 in lung transplant recipients (LTR) results in case-fatality rate of 10-46%. Disease severity is variable and it is unclear why certain groups of patients develop severe disease. Recent report suggests that 10% of patients with life threatening COVID-19 have auto-antibodies (AAbs) against type 1 interferons (IFN-1) but very few describe their impact in LTR. We therefore sought to identify AAbs in LTR with COVID-19 by using a customized proteomic microarray (CPM) bearing 120 antigens. Methods We retrieved samples collected for routine care within 3 months prior to and after diagnosis of COVID-19 of 13 LTR. IgA and IgG AAbs were analyzed using CPM. Predefined antibody score (ab-score) was used for downstream analysis. COVID severity was defined as per center for disease control guidelines. Changes in ab-scores from pre- to post-COVID were assessed via Wilcoxon signed-rank tests; association between continuous variables and AAbs using Spearman's correlation. Linear mixed-effects models were used to analyze the association between changes in AAbs pre- to post-COVID and COVID severity. Results Among 13 LTR COVID severity was moderate (n=6), severe (n=4) and critical (n=3). Levels of 76 IgA antibodies and 9 IgG antibodies increased between pre and post covid samples (FDR adjusted p<0.05). In exploratory analysis, antibody response over time for one IgA antibody (IgA Nucleosome) and four IgG AAbs correlated with higher COVID severity (unadjusted p<0.05). IFN lambda is an antiviral cytokine and AAbs to it correlated with COVID severity (p=0.031). Such AAbs are shown to block the ability to block SARS-CoV-2 in vitro. No significant differences were observed in antibody response in the groups who were alive (n=9) versus deceased (n=4) and three inflammatory markers, ferritin, D dimer and absolute lymphocyte count. Conclusion Change in antibody response of five AAbs correlated with COVID severity in a small group of LTR. The results of this study are considered exploratory and need further validation. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3684 | Feasibility of Single Lung Transplant for Post-COVID Fibrosis: A Case Report Introduction Previously we reported bilateral lung transplantation is the last treatment option for irrecoverable COVID ARDS and post-COVID fibrosis. Now we report our first single lung transplant (SLTx) for post-COVID fibrosis. Case Report A 59-year-old, never-smoker, female, with history of obstructive sleep apnea, hypertension and hyperlipidemia, presented to an outside hospital with COVID-19, shortness of breath, and bilateral pulmonary infiltrates on chest X-ray (CXR) (Figure 1a). She was admitted to the intensive care unit, never requiring intubation, for an overall 40-day hospitalization. At discharge, she had shortness of breath with minimal activity and required continuous oxygen (O2) therapy. One year later she presented to our institution for an outpatient lung transplant evaluation for her post-COVID fibrosis. Her cardiac work up was unremarkable, with the absence of pulmonary hypertension on echocardiogram and right heart catheterization. Computed Tomography of her chest showed only significant fibrosis in the upper lobes with traction bronchiectasis and volume loss (Figure 1c). Her lung ventilation perfusion scan showed grossly normal perfusion to both lungs. Thus, she was listed for left, right, and bilateral lungs with a Lung Allocation Score of 42. After 39 days of listing, she underwent left SLTx. Final pathology of her explanted lung (Figure 1d) showed both uninvolved lung parenchyma and interstitial fibrosis and capillary congestion (Figure 1e). Post-operatively, her course was unremarkable and she was discharged home on POD 19. She was seen in clinic on POD 22 and doing well with no need for supplemental O2 and improving CXR (Figure 1b). Summary SLTx can be used to treat debilitating post-COVID lung fibrosis when there is the absence of severe lung damage and pulmonary hypertension. Considering SLTx in these patients is necessary to expand the donor pool of lungs for a population of patients that will continue to grow with the continued COVID-19 pandemic. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3685 | Outcomes of COVID-19 Infection in Patients with Left Ventricular Assist Device Purpose Left ventricular assist device (LVAD) patients are presumed to be high risk for novel SARS-CoV2 virus complications given their multiple comorbidities. Data on COVID-19 outcomes in LVAD patients is limited. Our single-center, retrospective, cohort study aimed to study the characteristics and outcomes of LVAD patients with COVID-19 infection. Methods Institutional IRB approval was obtained. A total of 70 Heartmate 3 (HM3) LVAD patients at our center were screened from December 2019 - September 2021. Variables analyzed included mortality, need for hospitalization, respiratory failure, thromboembolic events, bleeding events, and International Normalized Ratio (INR). Results The rate of COVID-19 infection in our cohort of 70 patients was 15.7% (n=11) similar to the rate observed in the state of Texas (14.1%). The average time interval between LVAD implantation and COVID-19 infection was 41.1 months. 63% (n=7) patients when to ER/hospitalized with a mortality rate of 9% (n=1). All patients had community-acquired infections except one patient who acquired from a visiting family member at the hospital. 81% (n=9) patients acquired the infection during a period of high-infectivity rate in the state of Texas (November 2020-February 2021). Cough was the most common symptom (63.3%, n=7). No patient required intubation. One patient with DNR status who was also unvaccinated died of acute respiratory failure. Three patients developed chronic hypoxic respiratory failure. There were no incidents of pump thrombosis, strokes, or pulmonary embolisms. 72% of patients had an INR >2.0 closest to testing COVID+ with an average INR of 3.5 (range: 1.3 - 9.7). As of September 2021, 63% are vaccinated. Conclusion COVID-19 infection in LVAD patients can result in substantial morbidity requiring hospitalization and/or death. Interestingly, in our series, no patients suffered a thromboembolic event. Thus, the superior hemocompatibility of the Heartmate 3 device seems resistant to the reputed hypercoagulability of COVID infection. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3686 | Using Donor-Derived Cell-Free DNA for Assessment of Myocardial Injury in Heart Transplant Recipients After SARS-CoV-2 Infection Purpose A link between SARS-CoV2 infection and myocardial injury has been described. Our center utilizes non-invasive surveillance with gene expression profiling and donor-derived cell-free DNA (dd-cfDNA) in heart transplant (HTx) patients who are either stable or in whom invasive surveillance is contraindicated. We evaluated whether HTx recipients diagnosed with SARS-CoV2 infection demonstrated evidence of myocardial allograft injury using dd-cfDNA. Methods HTx recipients were included if they had dd-cfDNA testing (AlloSure; CareDx Inc., Brisbane, CA) within 60 days of their initial SARS-CoV2 diagnosis. Data on hospitalization, therapy, and clinical outcomes was captured. Dd-cfDNA results at the assay limit of detection (LOD, <0.12%) were set equal to the LOD. Results Between 3/2020 and 6/2021, we identified 12 HTx recipients with SARS-CoV2 and dd-cfDNA results within the specified time period; median age was 55 (IQR 28 - 64.5) with infection occurring 506.5 days (IQR 176 - 803.5) after transplant. Mean dd-cfDNA was 0.13 ± 0.03%, assessed 26 (IQR 20 - 35) days after infection. Prior results, available for 9 patients and obtained a median of 33 (IQR 27 - 59) days prior to infection, did not differ from post-infection values (0.13 ± 0.02%, p = 0.66). Following diagnosis, 8 (67%) patients were hospitalized; 5 had mycophenolate held, 2 received steroids, 2 received convalescent plasma, 4 received remdesivir, and 1 received monoclonal Ab therapy. At a median follow-up time of 304 (IQR 212.5 - 331) days after diagnosis, all twelve patients were alive with good allograft function (mean ejection fraction 59 ± 4.8%); interval clinically-relevant immunologic outcomes included one episode of rejection (pAMR1) and three (25%) findings of de novo donor-specific antibodies (dnDSA). Conclusion In this single-center pilot study assessing myocardial injury among HTx recipients within 2 months of SARS-CoV2 infection, the majority of patients had low dd-cfDNA results (<0.15%) and demonstrated good intermediate-term (6-12 months) graft function. While limited by sample size and protocol-based inclusion criteria, our findings suggest that sustained myocardial injury in HTx recipients after SARS-CoV2 infection may not be common. The impact of SARS-CoV2 infection on immunologic outcomes including rejection and dnDSA in this population merit further study. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3687 | Lung Transplant from a DCD Donor with a Previous Symptomatic COVID Infection Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a worldwide pandemic affecting more than 172 million confirmed cases. The likelihood of historic donor infection is increasing. Here we report a lung transplantation of a previously SARS-CoV-2 positive organ donor. Case Report A 49-year-old female who underwent left single lung transplantation for interstitial lung disease. The lung was obtained from a donation after cardiac death (DCD) using abdominal rerperfusion of a 23 years old female donor died of intracranial bleeding with history of covid infection 8 month prior to lung donation. According to the donor records, the symptoms were mild, and required no hospital admission. She had ongoing loss of taste and smell till time of donation. There were no respiratory symptoms. At time of retrieval, chest x ray was normal and blood gases were normal, however, bronchoscopy revealed severe inflammation of the right-side mucosa so the decision was to proceed with the left lung only as it had normal blood gases, good recruitment and no consolidation as well as non inflamed bronchial mucosa. patient had single off pump left lung transplant through left anterior thoracotomy approach. After the surgery, patient was extubated on day 1 in ICU, discharged from ICU on day 3 and discharged from the hospital after 27 days. There was no evidence for primary graft dysfunction or acute rejection. After 6 month of the surgery, FVC is 2.26 L (78.2% predicted) and FEV1 is 1.9L (70.2% predicted). Summary This case showed that it is possible to proceed with lung transplant from a donors who had previous mild covid infection. As DCD donation might limit preoperative invasive investigations such as bronchoscopies careful examination and proper radiological and functional assessment for the donor lung after donation including EVLP needs to be considered. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3688 | Lung Transplantation in COVID-19 Induced End Stage Lung Disease Introduction In a subset of patients COVID-19 induced lung injury progresses to irreversible lung damage and pulmonary fibrosis. Bilateral orthotopic lung transplant (BOLT) has been used as a rescue therapy in these patients. We describe four patients who were bridged to BOLT using venovenous extracorporeal membrane oxygenation (VV-ECMO). Case Report Between October 13, 2020 and February 14, 2021, four patients with SARS-CoV-2 infection underwent BOLT for end-stage pulmonary fibrosis demonstrated on computed tomography. Median age was 42 years and three were male. One patient had a prior history of undifferentiated interstitial lung disease managed with chronic steroids. Pre-transplant hospital course was complicated by right ventricular failure due to pulmonary hypertension in two patients and ventilator-associated pneumonia in one. One patient developed heparin-induced thrombocytopenia requiring anticoagulation with bivalirudin perioperatively. Three patients were non-ambulatory and bedridden for a median of 54 days prior to surgery. Timing of transplantation ranged from hospital day 26 - 68 with a median of 48 days. At the time of transplant, three patients were mechanically ventilated via tracheostomy, while all were on VV-ECMO a median of 27 (IQR 11 - 42) days. All patients underwent BOLT via clamshell exposure utilizing cardiopulmonary bypass (CPB) with aortic and right atrial cannulation. VV-ECMO was discontinued intraoperatively in all cases after initiating CPB. All patients required intraoperative blood transfusion with a median of 3 units. The three patients with tracheostomy prior to transplant were liberated from the ventilator a median of 9 days postoperatively and decannulated from their tracheostomy a median of 11 days postoperatively. Aside from one patient requiring short courses of hemodialysis, there were no significant postoperative complications. Patients were discharged a median of 17 (14 - 20) days following surgery. After a median follow-up of 226.5 (223 - 257.75) days, all four patients were alive with no supplemental oxygen requirement. Summary Pulmonary fibrosis secondary to COVID-19 pneumonia can be successfully treated with VV-ECMO and subsequent lung transplantation in select patients. Special consideration should be given to this patient population as they may not meet traditional listing requirements. We report a 100% oxygen-free survival rate at six months. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3689 | A Rare Case of COVID-19 Induced Multisystem Inflammatory Syndrome in Adult (MIS-A) Requiring Venoarterial ECMO (VA-ECMO) Introduction MIS-A is a rare COVID-19 induced condition defined by fever, new-onset severe cardiac illness, rash, encephalopathy, and elevated inflammatory markers in the setting of positive serum COVID-19 antibodies. This inflammatory cascade can cause significant biventricular dysfunction and subsequent cardiogenic shock. Patients with MIS-A can require temporary cardiac support including VA-ECMO. We present a case of a patient requiring VA-ECMO secondary to MIS-A induced heart failure and cardiogenic shock, with eventual myocardial recovery. Case Report 30-year-old male with type two diabetes was admitted with acute hypoxic respiratory failure, multiorgan failure, acute systolic biventricular heart failure, and COVID-19 infection four weeks prior. He was intubated and placed on vasopressors, antibiotics, and steroids for concerns for combined cardiogenic and septic shock. TTE noted global hypokinesis and 10-15% EF. EKG was sinus rhythm. He had mildly elevated troponins. Inflammatory markers including D-dimer, fibrinogen, and IL-6 were highly elevated. Despite antibiotics and supportive measures, the patient developed worsening hypoxia and hypotension. IVIG was also initiated, with deferral of plasmapheresis. At this time, MIS-A was suspected. The patient was approved for VA-ECMO as a means for bridging to cardiac recovery. He required VA-ECMO for four days, with ability to decannulate, extubate, and wean off vasopressors. COVID-19 antibody testing was positive. Infectious workup was negative, with the patient transitioned off antibiotics and steroid regimen after completing treatment course. Inflammatory markers improved. Repeat TTE noted 44% EF with improved biventricular function. Cardiac MRI one day later, noted 61% EF without evidence of scar, myocarditis, or perimyocarditis. He was discharged home after a total of 8 days of treatment with follow-ups scheduled. Summary This case highlights a severe presentation of MIS-A and showcases the benefit of VA-ECMO as a bridge to myocardial recovery. VA-ECMO has been shown to improve in-hospital survival and serve as a mechanism for cardiac recovery in acutely ill patients. Long-term cardiac effects and recovery rates post COVID-19 induced MIS-A remain unknown. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3690 | Effect of COVID-19 Infection on HeartCare, Data from the SHORE Multicenter Registry Purpose Transplant patients represent a cohort in which COVID-19 (C19) may stimulate an unpredictable clinical course. The aim of this study was to evaluate the impact of C19 infection on AlloMap gene expression profiling (AM) and AlloSure donor derived cell free DNA (AS) results in patients post heart transplant. Methods The Surveillance Using HeartCare Outcomes Registry (SHORE) is a multicenter study for post heart transplant patients followed with AM/AS for 5 years. Patients enrolled were analyzed based on C19 . AM/AS were evaluated before, at the time and following infection. Both individual trends and the differences between the median AS and AS levels were studied. Nonparametric tests were used to assess categorical and longitudinal variables. Results 21 patients developed C19 infection; 16 (76%) were males, median age 50 years. There was no significant difference in AM or AS in stable patients (no rejection, CAV, graft dysfunction, dnDSA) compared to the first AM/AS profile in the C19+ patients, Figure 1. Event rates in C19+ patients are described in Table 1. 12 C19+ patients had 28 biopsies, 2 of which were within 30 days of C19. 1 patient had ACR 2R and another AMR 1; all other biopsies were | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3691 | Out of the Frying-Pan and into the Fire: Transplant Candidate Selection in Acute Lung Failure Due to SARS-CoV-2 Infection Purpose The COVID-19 pandemic led to unprecedented rates of acute lung failure (ALF), and a rise in lung transplantation (LTx) referrals. Data on LTx in ALF is limited to LTx outcomes, and the unpredictable course of SARS-CoV-2 makes candidate selection challenging. This study summarizes our experiences, in both patients transplanted and those we declined. Methods LTx referrals for ALF due to SARS-CoV-2 between 01Apr20-01Oct21 were reviewed. Set parameters were collected prospectively. Acceptance criteria reflected previous guidance. Cases were discussed at our multi-disciplinary meeting and suitable candidates evaluated at source before transfer for consent and listing. Internal follow-up and external data from declined patients were retrospectively analysed, with survival to discharge and length of hospital stay as end-points. Results 45 patients were referred (78% male). Median age was 55.8 [IQR 47.6-59.8] years. 36 (80%) required both mechanical ventilation and vvECMO, of median duration 46 [31-82] and 34 [24-72] days respectively. Consolidation was the commonest CT finding (47%). Bacterial colonisation (23/45, 51%), coagulopathy (21/45, 47%) and hepatic dysfunction (11/45, 24%) were common. Twenty-two patients were conscious, of whom 21 were evaluated. Five patients died during evaluation, from either sepsis or bleeding. One failed evaluation, and one withdrew consent. Six patients improved, making urgent LTx unnecessary, with 5 attending our review clinic. Of the 8 patients successfully evaluated, one died unexpectantly awaiting transfer, one improved at listing and a further patient died of sepsis after listing. Three patients underwent LTx, all being discharged home at 3 months post-LTx. Conclusion LTx candidate selection in critically ill SARS-CoV2 patients is challenging. Late recovery, particularly in non-fibrotic ALF is not unusual. Decision-making needs to include “acceptable morbidity” as a prelude to delayed evaluation and perhaps listing. More data is needed about declined candidates, particularly unweanable sedated patients with single-organ failure. Even successful awake recipients may experience significant psychological injury, underlining previous arguments in sedated patients. Equity to all candidates needs consideration, given the extraordinary demands on organ availability and care resources. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3692 | Large Variation in Heart Transplant Selection Practices During the COVID-19 Pandemic Purpose A growing proportion of transplant donors and recipients have a history of COVID infection. Transplant societies issued guidelines to support decisions regarding donor selection and recipient activation after COVID infection, but outcome data are still limited. This study sought to characterize heterogeneity in current clinical practice and opinions regarding cardiac donation after recipient or donor COVID infection. Methods An online survey was distributed to heart transplant clinicians through a professional society message board and social media. Responses were collected between September 29 and October 18, 2021. Results 204 healthcare professionals from diverse geographic regions (North and South America, Europe, Middle East, Asia and Australia) completed the survey, including 143 (70%) transplant cardiologists, 42 (21%) cardiac surgeons and 19 (9%) other heart transplant clinicians. 80% of clinicians felt COVID vaccine should be mandatory before transplant. There was significant variation in clinical practice for donor acceptance and recipient management, including several scenarios directly addressed by society guidelines - see Figure 1 for a sample of responses. Conclusion There is significant variation in the clinical approach to common scenarios following donor or recipient COVID infection. This reflects continued uncertainty with post-transplant outcomes impacted by pre-transplant COVID infection. Granular outcome data are needed to better inform clinical decisions. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3693 | COVID-19 Vaccination Motivation and Hesitancy in Heart Transplant Recipients During a Global Health Crisis Purpose Heart transplant (HT) recipients are at increased risk of acquiring SARS-CoV-2 (COVID-19) and infection related complications, which can lead to long term morbidity and mortality due to their immunosuppressed status. COVID-19 vaccination is strongly recommended for transplant recipients. However, the motivating and limiting factors to vaccination in HT recipients remain unknown. Methods A 26 question survey was mailed to all adult HT recipients at our center to assess the number of patients who received a COVID-19 vaccine as well as motivating and limiting factors to vaccination. Surveys with 3 or more incomplete answers were excluded. Results Ninety (36.1%) of 249 HT recipients returned the survey, with 5 surveys excluded and 85 evaluated. Selected responses are reported in the table. Of assessed surveys, 82 (96.5%) patients received a COVID-19 vaccine with primary motivating factor to protect their own health (86.9%). A majority of respondents were very (45.9%) or moderately concerned (23.5%) about getting COVID-19 infection. While most patients (57.7%) reported no concern about getting the vaccine, 23 respondents listed a vaccine-related concern. A high percentage (67.9%) of patients reported obtaining certain information about the vaccine which they could not determine to be true or false. The most trusted source for vaccine information was a transplant provider (80%). Of 3 non-vaccinated respondents, none listed a specific concern related to the vaccine; 2 of the 3 (66.7%) had previously confirmed COVID-19 infection. Conclusion A high percentage of responding HT recipients received a COVID-19 vaccine. Patients were primarily motivated to protect their own health and reported low concern about receiving a vaccine. Transplant providers were a highly trusted source of information, suggesting an important role for the transplant team in encouraging vaccination. | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3694 | Outcomes by Severity of Obesity During ECMO Support for COVID-19 Purpose Obesity adversely impacts outcomes during COVID-19 but its relation to mortality in those receiving extracorporeal membrane oxygenation (ECMO) is uncertain. Methods A retrospective multicenter study was conducted. Adult patients (≥18 years old) with severe COVID-19 infection placed on ECMO between March 1, 2020 to April 30, 2021, across the United States were included. A web-based database application, REDCap, was utilized to capture clinical characteristics and outcomes. Patients were grouped into tertiles of body mass index (BMI). The primary outcome was in-hospital mortality after ECMO placement assessed by a time-to-event analysis. Results Overall 444 patients (age 49, IQR: 38-57 years, 29% female, BMI: 33, IQR: 29-39 kg/m2) from 17 centers comprised the study cohort. Patients that expired during hospitalization had a similar BMI in comparison to those that were discharged (33, IQR: 29-38 vs. 34, IQR: 30-40 kg/m2, p=0.13). BMI across groups was 27, IQR: 25-29 (lowest tertile), 33, IQR: 32-34 (middle tertile), 41, IQR: 38-45 kg/m2 (highest tertile). At 90 days, in-hospital mortality between BMI tertiles was 53%, 59%, and 53%, p=0.99 (figure). After adjustment for clinical covariates including age, sex, presence of preexisting co-morbidities, cardiopulmonary arrest prior to ECMO, serum creatinine and arterial partial pressure of oxygen (PaO2) to inspired oxygen concentration (FiO2) ratio, there was no difference in hospital mortality in the middle (aHR:1.13, CI: 0.79-1.63, p=0.5) and highest (aHR: 1.38, CI: 0.95-2.01, p=0.09) tertiles in comparison to the lowest BMI tertile. Conclusion Severity of obesity is not associated with death during hospitalization in patients placed on ECMO for COVID-19 | J Heart Lung Transplant | 2022 | CORD-19 | |
| 3695 | Covid-19: a novel challenge to human immune genetic machinery COVID-19 also called corona virus emerged in China in December 2019. This turned into a global pandemic in a short period of time. Covid-19 is a novel strain of corona virus that was not seen earlier in human beings. It is important to study the molecular structure of Covid-19 so as to aid in the development of therapeutic measures. Existing Covid-19 pandemic poses an extraordinary risk to health and healthcare systems worldwide. Corona viruses are made of single stranded RNA present within the coat proteins. The virus has a diameter of nearly 80–120 nm. Usually, Covid-19 presents with the signs and symptoms of respiratory illness. Cough commonly dry cough, fever, associated with myalgias and sometimes breathing difficulties due to decrease in oxygen saturation rates are also present in these patients. Some people show fever with body aches, while some are relatively asymptomatic. Corona virus is primarily transmitted in humans through respiratory route and is highly contagious. Mostly old people and those having comorbid illnesses suffer most. After invading into the human body, the virus may lead to a sequence of processes such as viral invasion, replication, and programmed cell death, that is, apoptosis. To control and prevent this viral infection, we need to study the molecular aspects of Covid-19 in detail so as to design therapeutic agents as well as for vaccine formation. The micro-RNA is defined as the single-stranded noncoding RNA molecule. They have a length of about 22 nucleotides approximately and help in the post transcriptional regulation of gene expression. Micro RNAs regulate many types of cancers in addition to Covid-19 and other infections. Viral micro RNA is a newer type of mi-RNA and controls the host cell expression and viral target genes. This was completed by inducing micro-RNA cleavage, breakdown, translation, inhibition, or other mechanisms. The micro-RNAs of Covid-19 are explained to give an authoritative means to study this novel coronavirus. These control the host cell expression and also viral target genes by inducing micro-RNA cleavage, breakdown, translation, inhibition, and also other mechanisms. | Immunogenetics: A Molecular an | 2022 | CORD-19 | |
| 3696 | Erythroderme Psoriasis nach COVID-19-Erkrankung We present a clinical case of a patient with acutely exacerbated erythrodermic psoriasis vulgaris after symptomatic infection with SARS-CoV‑2 (severe acute respiratory syndrome coronavirus 2). Various factors are already known that can lead to an exacerbation of psoriasis, such as drugs or infections with, for example, streptococcus. An association between psoriasis and an infection with SARS-CoV‑2 has been described so far in individual case reports, in which, however, drug treatment with for example hydroxychloroquine, a known trigger of psoriasis, often took place. Later cases of exacerbation of psoriasis, partly as pustular psoriasis have been published also without drug induction. However we present for the first time a case of erythrodermic psoriasis triggered by COVID-19 (coronavirus disease 2019) without an obvious drug trigger. | N/A | 2022 | CORD-19 | |
| 3697 | Magnetic Nanoparticles in Medicine: Progress, Problems and Advances The review presents an analysis of the current state of research related to the design, development, and practical application of methods for biomedical radioelectronics and nanomedicine, including the use of magnetic nanoparticles. The important role of rational scientific physical approaches and experimental methods in the design of efficient and safe magnetic nanoparticle-based agents for therapy, controlled targeted drug delivery, and diagnostics, including spatial imaging, is emphasized. Examples of successful practical application of magnetic nanoparticles in medicine based on these methods are given, and an analysis of the main problems and prospects of this area of science is conducted. | N/A | 2022 | CORD-19 | |
| 3698 | Does Financial Development Increase Education Level? Empirical Evidence from Sub-Saharan Africa This study analyzes the effect of financial development on education in a sample of 37 sub-Saharan African countries with data covering the period from 2000 to 2018. We use the nine measures of financial development proposed by the International Monetary Fund (IMF) and the three levels of education, including primary, secondary, and tertiary education. Applying the two-stage system Generalized Method of Moment (GMM), we find that financial development increases school enrollment in each level in sub-Saharan Africa. The gender results also show that financial development improves primary and secondary education for both male and female, except at the tertiary level where the effect does not appear to be robust for male. Based on these results, we suggest that the financial market and financial institution in SSA should be improved given its beneficial effects on the education system. | N/A | 2022 | CORD-19 | |
| 3699 | Upcoming Events in Pediatric Cardiology | Pediatr Cardiol | 2022 | CORD-19 | |
| 3700 | The influence of cause-related marketing campaign structural elements on consumers' cognitive and affective attitudes and purchase intention This study explored middle- to high income consumers’ awareness and opinions of cause-related marketing and the influences of selected campaign structural elements on consumers’ responses. The study was conducted using qualitative focus groups and a quantitative 2 × 2 × 2 × 2 factorial experiment. A communications approach was adopted to investigate consumer responses to the cause-related marketing communicated campaign itself with education as the beneficiary. The qualitative research revealed that South African consumers are positively disposed toward cause-related marketing in an educational context and that they prefer positive, prosocial campaign messaging. The experiment confirmed that campaign structural elements exert significant independent and interactive influences on consumer intentions, attitudes, and perceptions. A low-involvement product, a specific donation recipient, and a high magnitude actual amount donation were found to have the most significant impact on consumer responses. | N/A | 2022 | CORD-19 |
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(3) Currently tweets of June 23rd to June 29th 2022 have been considered.