The COVID-19 Pandemic and Adult Cardiac Transplantation: Impact, Interventions and Implications.

In this review, we provide a comprehensive overview of the impact of the COVID-19 pandemic on adult heart transplantation. We highlight the decline in the number of adult transplant performed throughout the pandemic as a consequence of restrictions imposed on individual programs and hospitals. There were challenges to maintaining cardiac transplant activity at multiple levels, including organ donation in intensive care units, logistical difficulties with organ procurement, and rapidly changing resource considerations at a health system and jurisdictional level. We also review the impact of COVID-19 on cardiac transplant recipients. Despite the high rates of morbidity and mortality observed during the initial phases of the pandemic among heart transplant patients infected with COVID-19, the availability of effective vaccines, pre-exposure prophylaxis, and specific anti-viral therapies have drastically improved outcomes over time. Vaccines have proven safe and effective in the reducing infections and illness severity, however specific considerations in the immunocompromised solid organ transplant population apply, including the need for additional booster doses to achieve sufficient immunization. We further outline the strong rationale for vaccination prior to transplantation wherever possible. Finally, the COVID-19 pandemic created a number of barriers to safe and efficient post-transplant care. Given the need for frequent evaluation and monitoring, especially in the first several months following cardiac transplantation, the pandemic provided the impetus to improve virtual care delivery and explore non-invasive rejection surveillance through gene expression profiling. We hope that lessons learned will allow us to prepare and pivot effectively during future pandemics and healthcare emergencies.