Do COVID-19 vaccines provide protection against severe SARS-CoV-2 infection and death in heart transplant recipients?
In this case-control study, heart transplant recipients from a single center who were vaccinated against SARS-CoV-2 had significantly lower risk of COVID-19 infection, hospitalization, and death with no transplant-related safety concerns.
Even though the immunogenic response to COVID-19 vaccination is lower in patients who receive a heart transplant, the vaccine appears to be safe and is associated with a lower risk of COVID-19 infection, hospitalization, and death, suggesting it is imperative that all heart transplant recipients obtain the COVID-19 vaccine.
Orthotopic heart transplant (OHT) recipients are at increased risk for morbidity and mortality after SARS-CoV-2 infection. Although antibody response to COVID-19 vaccination is lower in solid organ transplant recipients, there has been no study assessing the safety and effectiveness of COVID-19 vaccination in OHT recipients.
To assess the safety and effectiveness of COVID-19 vaccination and associations with SARS-CoV-2 infection and clinical outcomes in a large population of adult OHT recipients.
Design, Setting, and Participants
This case-control study examined data from a US heart transplant program at a single center for all adult recipients of OHT who were followed up from January 15, 2021, through January 31, 2022.
Main Outcomes and Measures
The primary outcome was number of SARS-CoV-2 infections and related hospitalizations, intensive care unit (ICU) admissions, and deaths between vaccinated vs unvaccinated adult recipients of OHT.
A total of 436 patients who received OHT were included in the study, of which 106 patients were infected with COVID-19. The mean (SD) age was 54 (17) years; 303 (69.5%) were men and 133 (30.5%) were women. There were 366 patients in the vaccinated cohort with 72 COVID-19 infections (19.7%), 15 hospitalizations (4.1%), 4 ICU admissions (1.1%), and 3 deaths (0.8%). There were 70 patients in the unvaccinated cohort with 34 COVID-19 infections (48.6%), 10 hospitalizations (14.3%), 3 ICU admissions (4.3%), and 3 deaths (4.3%). COVID-19 vaccination was associated with a lower risk of COVID-19 infection (risk ratio [RR], 0.41; 95% CI, 0.30-0.56), hospitalization (RR, 0.29; 95% CI, 0.14-0.61), and death (RR, 0.19; 95% CI, 0.05-0.82). Among the 366 vaccinated OHT recipients, there was no echocardiographic evidence of graft dysfunction, clinically significant rejection, or allosensitization at 6 months after they received the COVID-19 vaccine.
Conclusions and Relevance
Patients with OHT who are infected with SARS-CoV-2 are at greater risk of severe infection and death compared with immunocompetent individuals. COVID-19 vaccination was associated with fewer COVID-19 infections, hospitalizations, and deaths, with no heart transplant–specific adverse events. COVID-19 vaccination for all OHT recipients is of paramount importance.
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Accepted for Publication: March 4, 2022.
Published Online: April 27, 2022. doi:10.1001/jamacardio.2022.0670
Corresponding Author: Laura L. Peters, DNP, FNP, School of Medicine, University of Colorado, 12631 E 17th Ave B-130, Aurora, CO 80045 (email@example.com).
Author Contributions: Dr Peters had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Peters, Pal, Ambardekar.
Acquisition, analysis, or interpretation of data: All authors.
Drafting of the manuscript: Peters, Pal, Ambardekar.
Critical revision of the manuscript for important intellectual content: All authors.
Statistical analysis: Peters, Pal, Ambardekar.
Administrative, technical, or material support: Peters, Pal, Ambardekar.
Supervision: Raymer, Pal, Ambardekar.
Conflict of Interest Disclosures: None reported.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
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