key: cord-0822635-lxp67sx1
authors: Bennett, David; De Vita, Elda; Ventura, Vittoria; Bernazzali, Sonia; Fossi, Antonella; Paladini, Piero; Luzzi, Luca; Maccherini, Massimo; Valente, Serafina; Bargagli, Elena; Frediani, Bruno; Sestini, Piersante
title: Impact of SARS‐CoV‐2 outbreak on heart and lung transplant: A patient‐perspective survey
date: 2020-08-10
journal: Transpl Infect Dis
DOI: 10.1111/tid.13428
sha: ba15c97b90aa77f30e219285794726a4206233d5
doc_id: 822635
cord_uid: lxp67sx1

BACKGROUND: The risk of COVID‐19 is expected to be higher among solid organ transplant. The aim of the present study was to evaluate the incidence of COVID‐19 and the impact of the SARS‐CoV‐2 outbreak on the personal hygiene and expectations in heart and lung transplant recipients. METHODS: A telephone survey of heart (n = 69) and lung (n = 41) transplant patients and a group of controls (n = 41) was conducted concerning personal hygiene before and after the outbreak; the impact on subjective expectations regarding graft outcome; symptoms possibly associated with SARS‐CoV‐2 infection; and diagnosis of COVID‐19. RESULTS: Seventy nine percent of the patients declared they increased the use of face masks and handwash. Behavior at home regarding self‐isolation did not change. About half the patients said they were afraid of the virus. A higher percentage of Lung transplant (LTX) were convinced that SARS‐CoV‐2 could have a negative impact on the outcome of their graft. 28% declared that they were afraid to come to the hospital for routine examinations and asked to postpone. Nine LTX and five Heart transplant (HTX) patients experienced symptoms that could have been associated with SARS‐CoV‐2 infection, but none of them underwent a nasopharyngeal swab. Only one LTX was diagnosed with the infection. CONCLUSIONS: In our study, we observed a low incidence of COVID‐19 in heart and lung transplant patients (0.9%), similar to that of the general population of our Region. Isolation measures were already observed before the pandemic and were further strengthened in most cases. Particular attention should also be paid to new psychological and physical complications indirectly linked to the COVID‐19 pandemic.

The risk of pneumonia and progression to septic shock and acute respiratory distress syndrome (ARDS) is expected to be higher among solid organ transplant recipients who contracted COVID-19 than in the non-transplant population. 1 However, it has been postulated that long-term post-transplant immunosuppression could somehow impede the hyperinflammatory syndrome caused by the cytokine storm that leads to multiorgan failure and deaths attributed to SARS-CoV-2. 2 The aim of the present study was to evaluate the incidence of COVID-19 in solid organ transplant recipients and the impact of the SARS-CoV-2 outbreak on the personal hygiene and expectations of heart (HTX) and lung (LTX) transplant patients by means of a patient-perspective survey. TA B L E 1 English translation of the questionnaire in Italian utilized to interview all participants

The following questions refer to usual hygiene practices before coronavirus: 

We conducted a telephone survey of heart and lung transplant patients monitored at the Regional Referral Centres for Heart and In consideration of the type of investigation, the audience for which it was intended and the medium with which we conducted the interviews (telephone), we set a closed-ended questions survey in Italian to be sure that the questions were received by all the respondents in the same way; the questionnaire was designed with the following characteristics: clarity, brevity, unambiguity, and com- 

The statistical analysis was conducted with GraphPad Prism v 6.0 for Macintosh; differences with P < .05 were considered significant.

The difference between the two groups was studied by t test; for comparing three or more groups, ANOVA analysis was used; differences in prevalence on contingency tables was tested with the Fisher or chi-square test. All data were expressed as mean ± standard deviation.

Lung transplant patients were significantly younger than HTX and controls. Immunosuppressive regimen was similar between groups;

however, less than half of HTX patients were on steroids, while all LTX patients were taking prednisone accordingly to our protocol.

In our cohort, 79% of the patients interviewed declared that they increased their use of face masks after outbreak of the pandemic; most were HTX patients: In this cohort, the routine use of masks was significantly lower than in LTX patients before the pandemic (11.6% vs 41.5%, respectively, P = .0007). Both groups also washed their hands more often/more thoroughly, despite the fact that most responders said that they already washed their hands more than 5 times a day before the pandemic. The percentage of HTX and LTX who used gloves before the COVID-19 outbreak was 23.18% and 14%, respectively, compared with 57.97% and 73.17% afterward (P < .0001 in both cases).

Neither group changed its behavior at home regarding self-isolation, which patients declared was only strictly observed in the first months after the transplant, whereas during the pandemic, subjects did not isolate themselves from the rest of the family. However, a significantly higher number of LTX declared that they already slept separately from their partner before pandemic (58.53% vs 21.73%,

The attitude toward COVID-19 was broadly similar in the two groups, where about half the patients said they were afraid of the 

Solid organ transplant patients would be expected to be at high risk of COVID-19 infection due to their immunosuppressed condition and comorbidities; however, a relatively low incidence has been reported in this population. 1 In our study, we observed a very low incidence of COVID-19 in heart and lung transplant patients Interestingly, a significantly higher percentage of controls than transplant patients reported negative expectations of SARS-CoV-2

outbreak on their disease even if they rarely reported the presence of symptoms that could be due to COVID-19. 

Authors have no conflicts of interest to disclose.

David Bennett performed study design, data collection, data analysis, and data interpretation, coordinated the study, and wrote the manuscript; Elda De Vita performed telephone interviews, data collection, and data analysis, and wrote the manuscript; Vittoria Ventura performed data collection and data analysis; Sonia Bernazzali, Antonella

Fossi, Piero Paladini, Luca Luzzi, Massimo Maccherini, Serafina

Valente, Elena Bargagli, and Bruno Frediani performed data collection and data interpretation; Piersante Sestini participated in study design and critical revision of the manuscript.

The research was approved by the local ethics committee (OSS_ REOS n° 12908).

All subjects gave their consent to the study.

https://orcid.org/0000-0001-5354-152X

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