Impact of COVID-19 on Lung Allograft and Clinical Outcomes in Lung Transplant Recipients: A Case-control Study

Abstract

Background. The impacts of COVID-19 on lung allograft function, rejection, secondary infection, and clinical outcomes in lung transplant recipients (LTRs) remain unknown. Methods. A 1:2 matched case–control study was performed to evaluate rehospitalization, lung allograft function, and secondary infections up to 90 d after COVID-19 diagnosis (or index dates for controls). Results. Twenty-four LTRs with COVID-19 (cases) and 48 controls were identified. Cases and controls had similar baseline characteristics and lung allograft function. LTRs with COVID-19 had higher incidence of secondary bacterial infection (29.2% versus 6.3%, P = 0.008), readmission (29.2% versus 10.4%, P = 0.04), and for-cause bronchoscopy (33.3% versus 12.5%, P = 0.04) compared with controls. At d 90, mortality in cases versus controls was 8.3% versus 2.1% (P = 0.21), incidence of invasive fungal infections in cases versus controls was 20.8% versus 8.3% (P = 0.13) and forced expiratory volume in 1 s (FEV1) decline ≥10% from baseline occurred in 19% of cases versus 12.2% of controls (P = 0.46). No acute cellular rejection, acute antibody-mediated rejection, or new donor-specific anti-HLA antibodies were observed among cases or controls within 90 d post index date. Conclusions. We found LTRs with COVID-19 were at risk to develop secondary infections and rehospitalization post COVID-19, compared with controls. While we did not observe post viral acute cellular rejection or antibody-mediated rejection, further studies are needed to understand if LTRs with COVID-19 who did not recover baseline lung function within 90 d have developed chronic lung allograft dysfunction stage progression.

COVID‐19 in lung transplant recipients: an overview of the Swedish national experience

“…The analysis shows a 28‐day, and overall mortality following COVID‐19 in this unselected LTx population of 4.2% and 14.8%, respectively. The 28‐day mortality is lower than in previously published LTx cohorts (9–34%) [ 6 , 7 , 8 , 9 , 10 ].…”

“…There are few studies with available pre‐COVID‐19 FEV1 from healthy patients to explore the course of FEV1 dynamic post‐COVID‐19 in nontransplanted patients, and there is only limited evidence that worse symptoms are associated with lower post‐COVID‐19‐FEV1 in a nontransplanted population [ 27 ]. Interestingly, a recent study found no significant difference in the loss of lung function between LTx recipients with COVID‐19 patients and matched controls over 90 days [ 9 ]. However, no detailed information on disease severity at presentation was included in this study.…”

“…However, detailed analyses of LTx recipients and long‐term follow‐up are still scarce. Furthermore, most published literature focuses mainly on hospitalized patients, and reports on LTx recipients developing COVID‐19 managed as outpatients are largely missing [ 6 , 7 , 8 , 9 , 10 ].…”

Post‐infection pulmonary sequelae after COVID‐19 among patients with lung transplantation

“…The post‐acute illness outcomes in the current report appear worse than the only other study evaluating post‐discharge outcomes among COVID‐19 patients, where an FEV1 decline > 10% was noted among five out of the 21 patients. 19 However, the differences are possibly linked to the variability in study design, inclusion criteria, and definition of endpoints. It appears that COVID‐19 patients in the current study ( n = 54) had more risk factors for the severe disease at presentation, as a higher proportion of patients had pertinent comorbidities such as diabetes (48.1%) and stage 3 or worse chronic kidney disease (46.3%).…”

“…Finally, the follow‐up period of the study by Permpalung et al. 19 was limited to 90 days which may have under‐estimated the post‐infection loss in lung functions.…”