CC Cardiol Croat Cardiologia Croatica Cardiol. Croat. 1848-543X 1848-5448 Croatian Cardiac Society CC 2021 16_11-12_345 10.15836/ccar2021.346 Cardiology and cardiovascular surgery Extended Abstract COVID-19 pneumonia in a heart transplant recipient https://orcid.org/0000-0002-8991-5025LovrićRužica1* https://orcid.org/0000-0001-8275-1702AldžićDora1 https://orcid.org/0000-0001-9912-2179UdovičićMario1 OremovićGoranka1 https://orcid.org/0000-0002-1878-0880BenkoIvica12 Klinička bolnica Dubrava, Zagreb, Hrvatska Zdravstveno veleučilište Zagreb, Zagreb, Hrvatska University Hospital Dubrava, Zagreb, Croatia University of Applied Health Sciences, Zagreb, Croatia Address for correspondence: Ružica Lovrić, Klinička bolnica Dubrava, Avenija Gojka Šuška 6, HR-10000 Zagreb, Croatia. / Phone: +385-1-290-2545 / E-mail: lovricruzica29@gmail.com 102021 16 11-12 345 345 07092021 14092021 2021 Croatian Cardiac Society KEYWORDS: chronic heart failureheart transplantationCOVID-19

Heart transplantation is a therapy of choice for patients with advanced terminal heart failure. A particular problem in these patients represents the titration of immunosuppressive therapy during infection, which is especially true in COVID-19.

We present a case of a heart transplant recipient, who was successfully treated for a severe COVID-19 pneumonia. The patient underwent the orthotopic heart transplantation in 2018 at the age of 52 due to ischemic cardiomyopathy. Early posttransplantation phase was uneventful, and his immunosuppressive regimen consisted of tacrolimus and mycophenolate mofetil. Following the recommendations he was fully vaccinated for COVID-19. Despite this, one month after the last vaccine, he presented to our emergency department with dyspnea, prostration, fatigue and respiratory insufficiency. A bilateral pneumonia caused by SARS-CoV-2 was verified, and he was hospitalized in the COVID-19 primary intensive respiratory center where high flow oxygen therapy was immediately initiated. The treatment was further complicated by secondary pneumonias, extending the duration of his hospital stay. Finally, after two months of hospital treatment the patient was discharged home.

The treatment of immunosuppressed heart transplant recipients for COVID-19 is an extraordinary clinical challenge, requiring an uneasy act of balance between a deadly infection and a potentially equally fatal heart transplant rejection. (1)

LITERATURE VaidyaGCzerLSCKobashigawaJKittlesonMPatelJChangD Successful Treatment of Severe COVID-19 Pneumonia With Clazakizumab in a Heart Transplant Recipient: A Case Report. Transplant Proc. 2020 November;52(9):2711–4. 10.1016/j.transproceed.2020.06.00332563584