COVID-19 in lung transplant recipients: A multicenter study

Abstract

This study describes the clinical presentation, treatment, and outcomes of SARS-CoV-2 infection in lung transplant recipients (LTRs). This is a multicenter, retrospective study of all adult LTRs with confirmed SARS-CoV-2 infection from March 4 until April 28, 2020 in six Spanish reference hospitals for lung transplantation. Clinical and radiological data, treatment characteristics, and outcomes were reviewed. Forty-four cases were identified in that period. The median time from transplantation was 4.2 (interquartile range: 1.11-7.3) years. Chest radiography showed acute parenchymal abnormalities in 32 (73%) cases. Hydroxychloroquine was prescribed in 41 (93%), lopinavir/ritonavir (LPV/r) in 14 (32%), and tocilizumab in 19 (43%) patients. There was a strong interaction between tacrolimus and LPV/r in all cases. Thirty-seven (84%) patients required some degree of respiratory support and/or oxygen therapy, and 13 (30%) were admitted to intermediate or intensive critical care units. Seventeen (39%) patients had died and 20 (45%) had been discharged at the time of the last follow-up.Deceased patients had a worse respiratory status and chest X-ray on admission and presented with higher D-dimer, interleukin-6, and lactate dehydrogenase levels. In this multicenter LTR cohort, SARS-CoV-2 presented with high mortality. Additionally, the severity of disease on presentation predicted subsequent mortality.

Incidence of SARS-CoV-2 in people with cystic fibrosis in Europe between February and June 2020

“…Upon SARS-CoV-2 infection, lung-transplanted pwCF were more frequently symptomatic, were admitted to hospital 1.7-fold more frequently and required intensive care 8-fold more frequently than pwCF without lung transplant. Previous studies also found that solid organ transplant recipients require more treatment and medical care upon SARS-CoV-2 infection, whether transplant was for CF [ 5 , 7 ] or other reasons [ 30 , 31 ].…”

Clinical characteristics, management practices, and outcomes among lung transplant patients with COVID-19

“…The earlier series describing COVID-19 in LT patients from the United States [ 6 , 17 , 18 ] as well as from Spain [19] , Belgium [20] and France [21] reported markedly variable patient outcomes despite being from the same time period. The hospital outcomes in the largest case series from Spain were poor, with more than 80% of the patients developing respiratory failure and nearly 40% succumbing to the infection.…”

“…The emergence of Coronavirus disease 2019 (COVID- 19), caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused significant morbidity and mortality across the world. The SARS-CoV-2 virus, while being highly infectious, does not have a high fatality rate among young and otherwise healthy people [1].…”

Community-Acquired Respiratory Viruses Post–Lung Transplant

“…Mortality ranged from 14 to 39%. [112][113][114] Treatment recommendations are rapidly changing, and limited guidance specific to solid-organ transplant recipients is currently available. At the time of this writing, the Infectious Diseases Society of America recommended the use of neutralizing monoclonal antibody therapies bamlanivimab and etesevimab for the treatment of high-risk ambulatory patients with mild to moderate disease.…”