ABSTRACT
Purpose The COVID-19 pandemic represents a major global health burden, and an important cause of morbidity and mortality nowadays. Data remains scarce on COVID-19 in lung transplant recipients (LTR). The purpose of this study was to understand impact of infection with COVID-19 in this population, to investigate different variables that contributed to the prognosis, and to assess the long-term clinical outcomes. This represents the largest cohort of continuously followed LTR with COVID-19 to date. Methods We conducted an observational retrospective cohort study of LTRs infected with COVID 19 at a major transplant center between June 2020 and April 2021. Infection was defined by having a positive diagnostic polymerase chain reaction (PCR) test. Patients’ characteristics, COVID severity and management were retrieved. Changes in individual patient's FEV1, imaging and trans-bronchial lung biopsies (TBLB) performed at 3, 6, and 12 month intervals after infection were compared to the baseline prior to infection. Results Fifty-three LTRs were identified as having COVID infection. Median age was 64 years, 31 (58.5%) were males, and 48 (90.5%) were double-LTR. Average BMI was 26.71 and 9 patients had diabetes. 38 (71.7%) patients were on three immunosuppression agents, and 4 (7.5%) patients had an augmented immunosuppression prior to COVID infection. 7 (13.2%) patients had at least one dose of mRNA COVID vaccine. 29 (54.7%) patients were treated as outpatient. Among admitted patients, 13 (24.5%) were treated in the ICU, and 7 (13.2%) required mechanical ventilation. Mortality rate was 15.1%. 26 patients had follow up on their FEV1 in 3 months, 33 in 6 months, and 7 up to 12 months. 14 (26.4%) patients had at least >10% drop in their FEV1, of which 10 patients had >20% drop. 18 patients had TBLB in 3 months, 19 in 6 months, and 4 in 12 months. Overall, 7 (13.2%) patients had acute cellular rejections (ACR). 23 patients had chest imaging at time of infection, with CT scan available for 10. Out of these, 6 showed pure ground glass opacities (GGO), and 4 showed mixed GGO and nodular opacities. Conclusion Out of our 53 LTR with COVID infection, 24.5% had severe disease. Mortality was high in our cohort at 15.1%. PFT decline was common, with 26.4% having an FEV1 drop of over 10% at follow up, suggesting persistent complications are common.