Association of COVID-19 Vaccination With Risk of COVID-19 Infection, Hospitalization, and Death in Heart Transplant Recipients | Cardiothoracic Surgery | JN Learning | AMA Ed Hub [Skip to Content]
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Association of COVID-19 Vaccination With Risk of COVID-19 Infection, Hospitalization, and Death in Heart Transplant Recipients

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Do COVID-19 vaccines provide protection against severe SARS-CoV-2 infection and death in heart transplant recipients?

Findings  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.

Meaning  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.

Abstract

Importance  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.

Objective  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.

Results  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.

Article Information

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 (laura.peters@cuanschutz.edu).

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.

References
1.
Latif  F , Farr  MA , Clerkin  KJ ,  et al.  Characteristics and outcomes of recipients of heart transplant with coronavirus disease 2019.   JAMA Cardiol. 2020;5(10):1165-1169. doi:10.1001/jamacardio.2020.2159PubMedGoogle ScholarCrossref
2.
Genuardi  MV , Moss  N , Najjar  SS ,  et al.  Coronavirus disease 2019 in heart transplant recipients: risk factors, immunosuppression, and outcomes.   J Heart Lung Transplant. 2021;40(9):926-935. doi:10.1016/j.healun.2021.05.006PubMedGoogle ScholarCrossref
3.
Bottio  T , Bagozzi  L , Fiocco  A ,  et al.  COVID-19 in heart transplant recipients: a multicenter analysis of the northern Italian outbreak.   JACC Heart Fail. 2021;9(1):52-61. doi:10.1016/j.jchf.2020.10.009PubMedGoogle ScholarCrossref
4.
Boyarsky  BJ , Werbel  WA , Avery  RK ,  et al.  Antibody response to 2-dose SARS-CoV-2 mRNA vaccine series in solid organ transplant recipients.   JAMA. 2021;325(21):2204-2206. doi:10.1001/jama.2021.7489PubMedGoogle ScholarCrossref
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Hallett  AM , Greenberg  RS , Boyarsky  BJ ,  et al.  SARS-CoV-2 messenger RNA vaccine antibody response and reactogenicity in heart and lung transplant recipients.   J Heart Lung Transplant. 2021;40(12):1579-1588. doi:10.1016/j.healun.2021.07.026PubMedGoogle ScholarCrossref
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Benotmane  I , Gautier  G , Perrin  P ,  et al.  Antibody response after a third dose of the mRNA-1273 SARS-CoV-2 vaccine in kidney transplant recipients with minimal serologic response to 2 doses.   JAMA. 2021;326(11):1063-1065. doi:10.1001/jama.2021.12339PubMedGoogle ScholarCrossref
7.
American Society of Transplantation and International Society of Heart and Lung Transplantation Joint Statement about Vaccine Efficacy in Organ Transplant Recipients. Published August 13, 2021. Accessed November 29, 2021. https://ishlt.org/ishlt/media/documents/ISHLT-AST_SARS-CoV-2-Vaccination_8-13-21.pdf
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