Heart transplantation management in northern Italy during COVID‐19 pandemic: single‐centre experience

Introduction Northern Italy is currently on the front line of European COVID‐19 outbreak and the first western region whose solid organ transplant programs have had to face the virus pandemic emergency. 1 Data on heart transplanted patients' management in the COVID‐19 era are still very limited. [...]the ability to grant best clinical practice in transplant population should answer to crucial questions, mainly regarding immunosuppression‐related issues. 2 First, severe infections in the immunocompromised population dramatically influence patient's prognosis. Despite a specificity greater than 95%, the rate of detectable anti‐SARS‐CoV‐2 IgM could range from 50% to 75%, depending on clinical phase of infection, and it is usually superior to 90% for IgG. 5 Moreover, CT scan should be considered when a graft is assigned, as it can detect typical ground glass and interstitial pneumonia aspects days before positivity of NPS and of symptoms occurrence. 8 Considering later result of serology, compared to NPS, the following combinations could be present: NP swab and r‐RT‐PCR: ○if negative: continue weekly test monitoring; the patient stays on active list. ○if positive: patient is referred to the local infectious disease centre and is suspended from the active list. ▪Immediate isolation of patient and caregiver. ▪If asymptomatic or paucisymptomatic: activate home self‐quarantine, with daily temperature monitoring and reporting of onset of symptoms. ▪Repeat serology (if not collected with the NPS at the same time): Since the first of March 2020, we have applied our transplant list management protocol, resulting in three successful heart transplantations in COVID‐19 negative recipients.