(414) Low Incidence of Long COVID in Heart Transplant Recipients

Heart transplant (HTx) recipients have increased morbidity from COVID-19 infection due to their immunosuppressed state. The CDC estimates 19% of patients with COVID-19 develop persistent symptoms following the acute infection, which may result from chronic inflammation. This is called post-acute sequelae of SARS-CoV 2 infection or “long COVID”. The incidence of long COVID in HTx recipients is unknown. We performed a retrospective analysis of all HTx recipients followed at a single center who developed COVID-19 and assessed for the frequency of long COVID. Patient data was collected from the electronic medical record. Surviving patients were interviewed using a standardized questionnaire. Patients rated their level of fatigue and pain for 6 months post COVID-19 on a scale from none (0) to very severe (5). 15 symptoms associated with long COVID were also graded. Long COVID was defined as having a score of ≥3 in fatigue or pain, along with a score of ≥3 in just one additional symptom. 162 HTx recipients had documented COVID-19 infections. 21 patients died between the acute infection and our survey. 13 of the 21 patients died due to COVID-19. Of the remaining 141 patients, 23 patients were unable to be reached for survey completion. The remaining 118 patients were included in the analysis. There were 84 men and 34 women. The median age was 60 (IQR 46-65) years; 46% were white, 22% black, 13% Hispanic, and 20% other ethnicities. The median time from transplant to COVID-19 infection was 8 (IQR 7.1-15.4) years. 66% of patients had received a COVID-19 vaccine at the time of infection. Immunosuppressive regimens included tacrolimus in 92%, cyclosporine in 5%, antiproliferative drugs in 75%, prednisone in 36%, and mTOR inhibitors in 14%. Fifty-five patients required hospitalization or emergency department evaluation. Treatments administered included steroids in 23%, Remdesivir in 20%, monoclonal antibodies in 43%, donated plasma in 9%, Paxlovid in 8%, and Evusheld in 1%. Of the 118 patients, only 4 (3%) met our criteria for long COVID. Only 1 of the 4 patients was hospitalized. Three of the 4 patients were vaccinated at the time of COVID-19 infection. Only 1 of the 141 surviving patients has been referred to a long COVID clinic. There is a low incidence of long COVID in heart transplant patients. Whether this is due to the use of long-term immunosuppression or heightened treatment during COVID is yet to be determined.