The risk of transmission of the novel coronavirus (SARS-CoV-2) with human heart valve transplantation: evaluation of cardio-vascular tissues from two consecutive heart donors with asymptomatic COVID-19
Tóm tắt
We report on two living donors of explanted hearts while receiving heart transplantation that tested positive for SARS-CoV-2 on the day of donation, although clinically asymptomatic. They underwent heart transplantation for ischaemic and hypertrophic obstructive cardiomyopathy, respectively. After evaluation of donor hearts, we cryopreserved and stored two pulmonary valves for clinical application and one aortic valve for research. Light microscopy of myocardium, mitral valve and aortic and pulmonary arterial wall and RT-PCR SARS-CoV-2 test of myocardium, mitral and tricuspid valve and aortic wall for detection of SARS-CoV-2 were performed. Presence of ACE2 in tissues was assessed with immunostaining. Light microscopy revealed a mild eosinophilic myocarditis in the ischemic cardiomyopathy heart, whereas enlarged cardiomyocytes with irregular nucleus and some with cytoplasmic vacuoles in the hypertrophic obstructive cardiomyopathy heart. Aortic and pulmonary wall were histologically normal. Immunostaining revealed diffuse presence of ACE2 in the myocardium of the heart with eosinophilic myocarditis, but only discrete presence in the hypertrophic cardiomyopathy heart. The RT-PCR SARS-CoV-2 test showed no presence of the virus in tested tissues. Despite eosinophilic myocarditis in the ischemic cardiomyopathy heart, no viral traces were found in the myocardium and valve tissues. However, ACE2 was present diffusely in the ischemic cardiomyopathy heart. SARS-CoV-2 could not be detected in the cardiac tissues of these COVID-19 asymptomatic heart donors. In our opinion, clinical application of the valves from these donors presents negligible risk for coronavirus transmission. Nonetheless, considering the uncertainty regarding the risk of virus transmission with the human tissue transplantation, we would not release in any case the pulmonary valve recovered from the eosinophilic myocarditis heart. In contrast, we may consider the release of the pulmonary valve from the dilated cardiomyopathy heart only for a life-threatening situation when no other similar allograft were available.
Tài liệu tham khảo
Aslam S, Mehra M (2020) COVID-19: Yet Another coronavirus challenge in transplantation. J Heart Lung Transplant 39(5):408–409. https://doi.org/10.1016/j.healun.2020.03.007
ASTS COVID-19 Strike Force Organ Retrieval Guidance (27 March 2020) https://asts.org/advocacy/covid-19-resources/asts-covid-19-strike-force/asts-covid-19-strike-force-organ-retrieval-guidance/
Bradley BT, Maioli H, Johnston R et al (2020) Histopathology and ultrastructural finding of fatal covid-19 infection. Lancet 396:320–332. https://doi.org/10.1016/S0140-6736(20)31305-2
Byambasuren O, Cardona M, Bell K (2020) Estimating the extent of true asymptomatic COVID-19 and its potential for community transmission: systematic review and meta-analysis. doi: https://doi.org/10.3138/jammi-2020-0030
Chang L, Yan Y, Wang L et al (2020) Coronavirus disease 2019: coronavirus and blood safety. Transfus Med Rev 34(2):75–80
Chen H, Wang C, Luo F (2020) Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet 395(10226):809–15
Chen L, Li X, Chen M (2020) The ACE2 expression in human heart indicated new potential mechanism of heart injury among patients infected with SARS-COV-2. Cardiovasc Res 116(6):1097–1100
Clerkin KJ, Fried JA, Raikhelkar J et al (2020) Coronavirus disease 2019 (COVID-19) and cardiovascular diseases. Circulation 141:1648–1655. https://doi.org/10.1161/circulationAHA.120.046941
Corman VM, Landt O, Kaiser M (2020) Detection of 2019 novel coronavirus 52019-nCoV) by real-time RT-PCR. Euro Surveill. https://doi.org/10.2807/1560.7917.ES.2020.25.3.2000045
Ding Y, He L, Zhang Q et al (2004) Organ distribution of severe acute respiratory syndrome (SARS) associated coronavirus (SARS-CoV) in SARS patients: implications for pathogenesis and virus transmission pathways. J Pathol 203:622–630. https://doi.org/10.1002/PATH.1560
ECDC (2020(1)) Coronavirus disease 2019 (COVID-19) and supply of substances of human origin in the EU/EEA 20 March 2020. https://www.ecdc.europa.eu/en/publications-data/coronavirus-disease-2019-covid-19-and-supply-substances-human-origin-eueea
ECDC (2020(2)) Coronavirus disease 2019 (COVID-19) and supply of substances of human origin in the EU/EEA - First update 29 April 2020. https://www.ecdc.europa.eu/en/publications-data/coronavirus-disease-2019-covid-19-and-supply-substances-human-origin
Gaudino M, Van Geldorp T, Daenen W, Kalmar P, Goffin Y (1997) Are pulmonary homografts subjected to pulmonary hypertension more appropriate for aortic valve replacement than normal pulmonary homografts? results of echocardiography in a multicentric study. Eur J Cardiothorac Surg 11(4):676–681. https://doi.org/10.1016/s1010-7940(96)01127-x
Gorbalenya AE, Baker SC, Baric SC et al (2020) The species severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2. Nature Microbiology 5:536–544. https://doi.org/10.1038/s41564-020-0695-z
Hong HL, Kim SH, Choi DL, Kwon HH (2020) A case of coronavirus disease 2019–infected liver transplant donor. Am J Transplant 2(10):2938–2941. https://doi.org/10.1111/ajt.15997
Jashari R, Van Hoeck B, Tabaku M et al (2004) Banking of the human heart valves and the arteries at the European homograft bank (EHB)- Overview of a 14-year activity in this International Association in Brussels. Cell Tissue Bank 5(4):239–251. https://doi.org/10.1007/s10561-004-1441-0
Jashari R, Goffin Y, Van Hoeck B (2010) Belgian and european experience with the European Homograft Bank (EHB) cryopreserved allograft valves assessment of a 20 year activity. Acta Chir Belg. 110(3):280–90
Kam KQ, Yung CF, Cui L (2020) A well infant with coronavirus disease 2019 (COVID-19) with high viral load. Clin Infect Dis. 71(15):847–849
Kates OS, Fisher CE, Rakita RM et al (2020) Use of SARS-COV-2-infected deceased organ donors: should we always “just say no?” Am J Transplant 20:1787–1794. https://doi.org/10.1111/ajt.16000
Lauer SA, Grantz KH, Be Q et al (2020) The incubation period of 2019-nCoV from publicly reported confirmed cases: estimation and application. Ann Intern Med 172(9):577–582. https://doi.org/10.7326/M20-0504
Lee S, Kim T, Lee E et al (2020) Clinical course and molecular viral shedding among; asymptomatic and symptomatic Patients With SARS-COV-2 infection in a community treatment center in the republic of corea. JAMA Internal Medicine 180(11):1447–1452. https://doi.org/10.1001/jamainternmed.2020.3862
Nandini S, Sundararaj SJ, Akihide R (2020) Interpreting diagnostic tests for SARS-COV-2. JAMA 323(22):2249–2251. https://doi.org/10.1001/jama.2020.8259
Nederlandse Transplant Stichting (NTS) (2020) Donor Selection Guideline SARS-COV-2/COVID-19 (06/05/2020). www.transplantatiestichting.nl
Oudit GY, Kassiri Z, Jiang CN et al (2009) SARS-coronavirus modulation of myocardial ACE2 expression and inflammation in patients with SARS. Eur J Clin Invest 39(7):618–625. https://doi.org/10.1111/j.1365-2362.2009.02153.x
To KKW, Tsang OTY, Chan KH et al (2020) Consistent detection of 2019 novel coronavirus in saliva. Clin Infect Dis 71(15):841–843
WHO (30 September 2020) Coronavirus Disease 2019 (COVID-19). htps://www.who.int/docs/ default-source/coronavirus/situation-reports/
Xia J, Tong J, Liu M et al (2020) Evaluation of coronavirus in tears and conjunctival secretions of patients with SARS-CoV-2 infection. J Med Virol 92(6):589–594. https://doi.org/10.1002/jmv.25725
Xiong T-Y, Redwood S, Chen M (2020) Coronavirus and the cardiovascular system: acute and long-term implication. Eur Heart J 41(19):1798–1800
Yong BE, Xiang SW, Kalimuddin S (2020) Epidemiology features and clinical course of patients infected with SARS-CoV-2 in Singapore. JAMA 323(15):1488–1494. https://doi.org/10.1001/jama.2020.3204JAMA