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Yaghmour N, Alramini D, Alsarayrah M, Abuassi M, Al-Rameni A, Aladaileh M, Al-Abdallat H, Rawashdeh B. COVID-19's impact on heart and lung transplantation: Citation-based analysis of research output. World J Transplant 2025; 15:99992. [DOI: 10.5500/wjt.v15.i2.99992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2024] [Revised: 12/26/2024] [Accepted: 01/11/2025] [Indexed: 02/21/2025] Open
Abstract
BACKGROUND Since being declared as a pandemic on March 11, 2020, coronavirus disease 2019 (COVID-19) has profoundly influenced heart and lung transplant programs, impacting donor availability, patient management, and healthcare resources. This study offers a citation-based review of the research output on this subject, seeking to understand how the transplant community has responded to these challenges. Through a review of literature from the beginning of the pandemic to early 2023, we evaluate the shifts in academic emphasis and the emerging trends in heart and lung transplantation during the COVID-19 period.
AIM To assess the impact of COVID-19 on heart and lung transplantation research, highlighting key themes, contributions, and trends in the literature during the pandemic.
METHODS We conducted an extensive search of the Web of Science database on February 9, 2023. We employed the terms "transplant" and "transplantation", as well as organ-specific terms like "heart", "cardiac", and "lung", combined with COVID-19-related terms such as "COVID-19", "coronavirus", and "SARS-CoV-2". The search encompassed publications from March 11, 2020 to February 9, 2023. Data on authors, journals, countries, institutions, and publication types (articles, reviews, conference papers, letters, notes, editorials, brief surveys, book chapters, and errata) were analyzed. The data was visualized and processed with VOSviewer 1.6.18 and Excel.
RESULTS We included 847 research items. There were 392 articles (46.3%) and 88 reviews (10.3%). The studies included were referenced 7757 times, with an average of 9.17 citations per article. The majority of the publications (n = 317) were conducted by institutes from the United States with highest citations (n = 4948) on this subject, followed by Germany, Italy, and France. The majority of papers (n = 101) were published in the Journal of Heart and Lung Transplantation.
CONCLUSION To the fullest extent of our knowledge, this is the first bibliometric study of COVID-19's impact on heart and lung transplantation to offer a visual analysis of the literature in order to predict future frontiers and provide an overview of current research hotspots.
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Affiliation(s)
- Nisreen Yaghmour
- Department of Cardiology, MercyOne Iowa Heart Center, Des Moines, IO 52302, United States
| | - Dina Alramini
- Department of Cardiothoracic Surgery, University of Arizona, Tucson, AZ 85702, United States
| | - Mohammad Alsarayrah
- Department of Vascular Surgery, University of North Carolina, Chapel Hill, NC 27599, United States
| | - Mohammad Abuassi
- Department of Internal Medicine, Jordan Hospital, Amman 00962, Al jamaimah, Jordan
| | - Awn Al-Rameni
- Department of Internal Medicine, University of Jordan, Amman 11698, Al jamaimah, Jordan
| | - Mohammad Aladaileh
- Department of Thoracic Surgery, University of Florida, Gainesville, FL 32605, United States
| | - Haneen Al-Abdallat
- Department of Medicine, Jordan University Hospital, Amman 11263, Al jamaimah, Jordan
| | - Badi Rawashdeh
- Department of Transplant Surgery, Medical College of Wisconsin, Milwaukee, WI 53202, United States
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Pearson BG, Walker DH, Lea AS, Khalife W, Kislingbury KK, Lick SD, Boor PJ. Early, rapidly progressive vasculopathy in a transplanted heart: A possible complication of COVID-19. Cardiovasc Pathol 2024; 72:107661. [PMID: 38801983 DOI: 10.1016/j.carpath.2024.107661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/18/2024] [Accepted: 05/21/2024] [Indexed: 05/29/2024] Open
Abstract
The epidemic caused by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has had a significant global impact, especially on immunosuppressed populations such as heart transplant recipients. While SARS-CoV-2 initially infects the respiratory system, cardiovascular complications induced by coronavirus disease 2019 (COVID-19) include cardiac arrest, myocardial infarction, heart failure, myocarditis, arrhythmia, acute myocyte injury, thrombotic events, and cardiogenic shock. Here, we present a case of a 45-year-old African American male who tested positive for COVID-19 infection six months after receiving a heart transplant. The patient was asymptomatic initially, but two weeks later he developed dyspnea, early satiety, and abdominal bloating. The patient was admitted to the hospital for acute renal failure and subsequently diagnosed with moderate acute T cell-mediated allograft rejection (Grade 2R) by endomyocardial biopsy. Three months after testing positive for COVID-19, the patient suffered a sudden cardiac death. At autopsy, the epicardium was diffusely edematous and showed vascular congestion. The coronary arteries showed a striking concentric narrowing of lumens and diffusely thickened arterial walls of all major extramural arteries deemed consistent with a rapidly progressive form of cardiac allograft vasculopathy (CAV). SARS-CoV-2 nucleocapsid protein was localized by immunohistochemistry (IHC) in endothelial cells of venules and capillaries within the epicardium. Our localization of SARS-CoV-2 in coronary vessel endothelial cells by IHC suggests that endothelial cell infection, endotheliitis, and immune-related inflammation may be a primary mechanism of vascular injury. The present case represents an early onset rapidly progressive form of CAV. This case may be the first case of post-transplant arteriopathy occurring in such a short time that includes corresponding autopsy, surgical pathology, and IHC data.
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Affiliation(s)
- Bryan G Pearson
- John Sealy School of Medicine, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, USA.
| | - David H Walker
- Department of Pathology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, USA
| | - Alfred S Lea
- Department of Infectious Diseases, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, USA
| | - Wissam Khalife
- Department of Cardiology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, USA
| | - Karen K Kislingbury
- Department of Cardiology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, USA
| | - Scott D Lick
- Department of Cardiovascular and Thoracic Surgery, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, USA
| | - Paul J Boor
- Department of Pathology, University of Texas Medical Branch, 301 University Blvd., Galveston, TX, USA
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Sharma S, Ruiz J, Nativi J, Patel P, Leoni J, Goswami R. The 90-Day Risk of Hospitalization in Heart Transplant Recipients After COVID-19 Infection. Transplant Proc 2024; 56:1496-1501. [PMID: 39097517 DOI: 10.1016/j.transproceed.2024.05.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/24/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Heart transplant recipients are at a high-risk of complications from the coronavirus-2019 (COVID-19) infection. Heart transplant recipients are a special group of persistently immunosuppressed people, and COVID-19 may cause them to experience an unpredictable course of infection, with a risk of hospitalization occurring well beyond their initial infection period. The seriousness of COVID-19 disease in heart transplant recipients emphasizes how vital it is to refer patients promptly and early to specialized heart transplant centers. METHODS We retrospectively reviewed all heart transplant recipients at a single center between March 2019 and October 2021. All recipients with positive nasopharyngeal reverse transcriptase-polymerase chain reaction tests for COVID-19 were included in this study. After IRB approval, we obtained medical records and patient data from electronic medical records. RESULTS This study followed 126 heart transplant patients from March 2019 to October 2021 of which only 49 had COVID-19 infections. The median age at infection was 58 years (49-65), with 41% female. Race distribution was as follows: 59% Caucasian and 39% African American. The median time from transplant to infection was 384 days (237-677). All infected patients had a 50% dose reduction in mycophenolate mofetil per institutional protocol. The majority of symptoms were cough, fatigue, shortness of breath, and fever. Among all patients with COVID-19, 45 (92%) were vaccinated. Of those vaccinated, 27 (60%) patients received Pfizer initial and booster doses, whereas 18 (40%) received Moderna initial and booster doses. Twelve patients (24%) were hospitalized within 90 days of infection, with only two requiring ICU level of care. The median duration of hospitalization was 5 days (4-9). Of the hospitalized patients, 11 (92%) were discharged, and 1 (8%) died in the hospital. Three of the four unvaccinated patients were hospitalized, and one died while hospitalized. The remaining 37 patients were managed as outpatients. CONCLUSION Heart transplant recipients have an increased risk of contracting COVID-19 and developing severe symptoms due to multiple healthcare contacts, preexisting health conditions, and weakened immune systems. Our data highlight that most vaccinated patients do not require hospitalization within 90 days of infection, and those hospitalized have a high likelihood of survival without needing ICU care.
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Affiliation(s)
- Shriya Sharma
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Jose Ruiz
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Jose Nativi
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Parag Patel
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Juan Leoni
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, Jacksonville, FL, USA
| | - Rohan Goswami
- Division of Heart Failure and Transplant, Mayo Clinic in Florida, Jacksonville, FL, USA.
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Sharma S, Ruiz J, Goswami R. Comparative Analysis of Coronavirus disease 2019 Vaccine Efficacy in Heart Transplant Recipients on Standardized Immunotherapy Regimens. Mayo Clin Proc Innov Qual Outcomes 2024; 8:241-248. [PMID: 38694147 PMCID: PMC11060941 DOI: 10.1016/j.mayocpiqo.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2024] Open
Abstract
Objective To assess the effect of coronavirus disease 2019 (COVID-19) infection on heart transplant recipients requiring immunotherapy. To investigate the effectiveness of vaccination in immunosuppressed heart transplant recipients during the initial years of the COVID-19 pandemic, and to examine the timing of COVID-19 infections in heart transplant recipients' posttransplantation. Patients and Methods International data on COVID-19 infection in immunosuppressed populations is limited. Heart transplant recipients requiring immunotherapy are at risk for increased complications with COVID-19 infection. The availability of vaccination and temporal trends in this population has not been well described. We report outcomes in immunosuppressed patients during the initial years of the COVID-19 pandemic from March 1, 2019, to October 31, 2021, at Mayo Clinic in Florida. Results A total of 98 patients were reviewed, of which 49 were COVID-19-positive (CP), and 49 were negative (CN). The cohort was well matched, with a median age of 58 years (49-65 years) in both groups. Females consisted of 41% in the CP group and 18.4% in the CN group. Immunosuppression was not significantly different for CP or CN patients. The median time from transplant to CP was 384 days (237-677 days). The CN group's median follow-up after transplant was 947 days (737-1191 days). The CP hospitalization rate was 24% with only 1 death. More CP patients were vaccinated than the CN group (92% vs 78%, P=.025). Conclusion Our study sheds light on COVID-19's effect on heart transplant recipients and vaccination in this population. Our findings suggest a potentially heightened infection risk within the first 1.5 years posttransplant, highlighting the need to optimize management strategies and vaccine efficacy in this vulnerable group.
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Affiliation(s)
- Shriya Sharma
- Division of Heart Failure and Transplant, Mayo Clinic, Jacksonville, FL
| | - Jose Ruiz
- Division of Heart Failure and Transplantation, Tampa General Hospital, Tampa, FL
| | - Rohan Goswami
- Division of Heart Failure and Transplant, Mayo Clinic, Jacksonville, FL
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MacKay M, Clewis M, Khalife W. Rapidly progressive graft vasculopathy in a heart transplant recipient with confirmed SARS-CoV-2 infection. Transpl Infect Dis 2024; 26:e14225. [PMID: 38152037 DOI: 10.1111/tid.14225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/10/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023]
Affiliation(s)
- Micaela MacKay
- The University of Texas Medical Branch John Sealy School of Medicine, Galveston, Texas, USA
| | - Madison Clewis
- The University of Texas Medical Branch John Sealy School of Medicine, Galveston, Texas, USA
| | - Wissam Khalife
- Division of Cardiovascular Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
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Cherrett C, Cao J, Adams C, Macdonald P. Coronavirus disease 2019 outcomes in heart transplant recipients: A large Australian cohort. J Heart Lung Transplant 2024; 43:346-349. [PMID: 37716497 DOI: 10.1016/j.healun.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 09/11/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023] Open
Abstract
Heart transplant recipients have been reported to be at a significantly elevated risk of poor outcomes from coronavirus disease 2019 (COVID-19) infection owing to their underlying comorbidities and immunosuppression. We conducted a single-center retrospective cohort of all heart transplant recipients who were known to have contracted COVID-19 between January 2020 and September 2022. Electronic medical records were used to collect baseline demographics, vaccination status, COVID-19 treatment received, hospitalization data, and mortality. Our primary end point was mortality, and our secondary endpoint was hospitalization. Between January 2020 and September 2022, 132 heart transplant recipients at our single-center contracted COVID-19 infection. Our population had high rates of vaccination, with 124 patients (94%) having received at least 2 vaccines. We found significantly lower rates of mortality and hospitalization than had been previously reported earlier in the pandemic, with a mortality rate of 8/132 (6%) and hospitalization rate of 21/132 (16%).
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Affiliation(s)
- Callum Cherrett
- St Vincent's Hospital Sydney, New South Wales, Australia; University of New South Wales, Australia.
| | - Jacob Cao
- St Vincent's Hospital Sydney, New South Wales, Australia; University of New South Wales, Australia
| | - Cobi Adams
- St Vincent's Hospital Sydney, New South Wales, Australia; University of New South Wales, Australia
| | - Peter Macdonald
- St Vincent's Hospital Sydney, New South Wales, Australia; University of New South Wales, Australia; Victor Chang Cardiac Research Institute, Sydney, Australia
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Ilonze OJ. Editorial commentary: Heart transplantation: Looking for the North Star. Trends Cardiovasc Med 2023; 33:51-52. [PMID: 34896480 DOI: 10.1016/j.tcm.2021.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 11/30/2021] [Indexed: 02/01/2023]
Affiliation(s)
- Onyedika J Ilonze
- Krannert Institute of Cardiology, Indiana University School of Medicine, 1801 North Senate Boulevard Suite 2000, Indianapolis, IN 46202, United States.
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Shoar S, Prada-Ruiz ACC, Patarroyo-Aponte G, Chaudhary A, Sadegh Asadi M. Immune Response to SARS-CoV-2 Vaccine among Heart Transplant Recipients: A Systematic Review. CLINICAL MEDICINE INSIGHTS: CIRCULATORY, RESPIRATORY AND PULMONARY MEDICINE 2022; 16:11795484221105327. [PMID: 35693423 PMCID: PMC9174554 DOI: 10.1177/11795484221105327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Accepted: 05/04/2022] [Indexed: 11/15/2022] Open
Abstract
Background Heart transplant (HTX) recipients are at a significantly higher risk of adverse clinical outcomes, due to chronic immunosuppression and co-existence of other chronic conditions, when contracting the SARS-CoV-2 infection. Although vaccination against SARS-CoV-2 is currently the most promising measure for the prevention of severe Coronavirus Disease 2019 (COVID-19) among solid organ transplant recipients, the extent of immune response and its protective efficacy among patients receiving HTX has not been sufficiently studied. Methods We performed a systematic review of the literature by inquiring PubMed/Medline to identify original studies among HTX recipients, who had received at least one dose of the SARS-CoV-2 vaccine. Data on the measured humoral or cellular immune response was collected from all the eligible studies. Factors associated with a poor immune response were further investigated within these studies. Results A total of 12 studies comprising 563 HTX recipients were included. The average age of the study participants was 60.8 years. Sixty four percent of the study population were male. Ninety percent of the patients had received an mRNA vaccine (Pfizer/ BNT162b2 or Moderna/mRNA-1273). A positive immune response to SARS-CoV-2 vaccine was variably reported in 0% to 100% of the patients. Older age (> 65 years), vaccine dose (first, second, or third), time since HTX to the first dose of the vaccine, the time interval between the latest dose of the vaccine and measurement of the immune response, and the type of immunosuppressive regimen were all indicated as potential determinants of a robust immune response to the SARS-CoV-2 vaccination. Conclusion HTX recipients demonstrate a weaker immune response to the vaccination against SARS-CoV-2 compared to the general population. Older age, anti-metabolite agents such as mycophenolate mofetil, and vaccination during the first year following the HTX have been indicated as potential determinants of a poor immune response.
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Affiliation(s)
- Saeed Shoar
- Department of Clinical Research, Scientific Collaborative Initiative, Houston, TX, USA
| | - Adriana C. Carolina Prada-Ruiz
- Division of Pediatric Cardiology, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Gabriel Patarroyo-Aponte
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Ashok Chaudhary
- Department of Internal Medicine, Griffin Hospital, Derby, CT, USA
| | - Mohammad Sadegh Asadi
- Division of Cardiology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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