A Proposed Strategy for Management of Immunosuppression in Heart Transplant Patients with COVID-19.

There is limited experience in management of orthotopic heart transplant (OHT) patients with COVID-19. In this study, we present our initial experience using a standardized management algorithm. Data collection was performed on OHT patients with COVID-19 after March 10, 2020 (declaration of state-of-emergency in Massachusetts). Among the 358 OHT patients currently followed at our program, 5 patients (1.4%) tested positive for COVID-19 (median age 50 years [IQR, 49-58], duration post-OHT 21 years [IQR, 6-25], and 4 of 5 (80%) were men). Among the 5 OHT patients, 2 of 5 (20%) had mild disease, and had no change in baseline immunosuppression therapy. Two of 5 (20%) had moderate disease, and received remdesivir as part of a clinical trial, and reduced immunosuppression therapy. One patient (20%) died prior to presenting to the hospital, consistent with 20% case fatality rate.