COVID-19 in Lung Transplant Recipients

Jonathan Messika, Philippine Eloy, Antoine Roux, Sandrine Hirschi, Ana Nieves, Jérôme Le Pavec, Agathe Sénéchal, Christel Saint Raymond, Nicolas Carlier, Xavier Demant, Aurélie Le Borgne, Adrien Tissot, Marie-Pierre Debray, Laurence Beaumont, Benjamin Renaud-Picard, Martine Reynaud-Gaubert, Jean-François Mornex, Loïc Falque, Véronique Boussaud, Jacques Jougon, Sacha Mussot, Hervé Mal, French Group of Lung Transplantation, Jonathan Messika, Philippine Eloy, Antoine Roux, Sandrine Hirschi, Ana Nieves, Jérôme Le Pavec, Agathe Sénéchal, Christel Saint Raymond, Nicolas Carlier, Xavier Demant, Aurélie Le Borgne, Adrien Tissot, Marie-Pierre Debray, Laurence Beaumont, Benjamin Renaud-Picard, Martine Reynaud-Gaubert, Jean-François Mornex, Loïc Falque, Véronique Boussaud, Jacques Jougon, Sacha Mussot, Hervé Mal, French Group of Lung Transplantation

Abstract

Background: A concern about the susceptibility of immunocompromised patients to the worldwide pandemic of coronavirus disease 2019 (COVID-19) has been raised. We aimed at describing COVID-19 infections in the French cohort of lung transplant (LT) patients.

Methods: Multicenter nationwide cohort study of all LT recipients with COVID-19 diagnosed from March 1 to May 19, 2020. Recipient main characteristics and their management were retrieved. Hospitalization characteristics, occurrence of complications and survival were analyzed.

Results: Thirty-five LT patients with a COVID-19 infection were included. Median age was 50.4 (40.6-62.9) years, 16 (45.7%) were female, and 80% were double-LT recipients. Infection was community-acquired in 25 (71.4%). Thirty-one (88.6%) required hospitalization, including 13 (41.9%) in the intensive care unit. The main symptoms of COVID-19 were fever, cough, and diarrhea, present in 71.4%, 54.3%, and 31.4% of cases, respectively. Extension of pneumonia on chest CT was moderate to severe in 51.4% of cases. Among the 13 critically ill patients, 7 (53.9%) received invasive mechanical ventilation. Thrombotic events occurred in 4 patients. Overall survival rate was 85.7% after a median follow-up of 50 days (41.0-56.5). Four of 5 nonsurvivors had had bronchial complications or intensification of immunosuppression in the previous weeks. On univariate analysis, overweight was significantly associated with risk of death (odds ratio, 16.0; 95% confidence interval, 1.5-170.6; P = 0.02).

Conclusions: For the 35 LT recipients with COVID-19, the presentation was severe, requiring hospitalization in most cases, with a survival rate of 85.7%.

Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

References

    1. Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2020;323:10611069
    1. Zhou F, Fan G, Liu Z, et al. SARS-CoV-2 shedding and infectivity—Authors’ reply. Lancet. 2020;395:1340
    1. CDC: Center for Disease Control and Prevention. 2020. Your health: People with certain medical conditionsAvailable at . Accessed June 27, 2020.
    1. Aslam S, Grossi P, Schlendorf KH, et al.; Working Group Members. Utilization of hepatitis C virus-infected organ donors in cardiothoracic transplantation: An ISHLT expert consensus statement. J Heart Lung Transplant. 2020;39:418–432.
    1. Guillen E, Pineiro GJ, Revuelta I, et al. Case report of COVID-19 in a kidney transplant recipient: does immunosuppression alter the clinical presentation? Am J Transplant. 2020;20:1875–1878.
    1. Zhu L, Xu X, Ma K, et al. Successful recovery of COVID-19 pneumonia in a renal transplant recipient with long-term immunosuppression. Am J Transplant. 2020;2018591863.
    1. Li F, Cai J, Dong N. First cases of COVID-19 in heart transplantation from China. J Heart Lung Transplant. 2020;39:496–497.
    1. Aigner C, Kamler M, Taube C. High-intensity interval training: the holy grail to top performance after lung transplantation? J Heart Lung Transplant. 2020;39:868–869.
    1. Kates OS, Fisher CE, Stankiewicz-Karita HC, et al. Earliest cases of coronavirus disease 2019 (COVID-19) identified in solid organ transplant recipients in the United States. Am J Transplant. 2020;20:1885–1890.
    1. Akalin E, Azzi Y, Bartash R, et al. Covid-19 and kidney transplantation. N Engl J Med. 2020;382:2475–2477.
    1. Huang JF, Zheng KI, George J, et al. Fatal outcome in a liver transplant recipient with COVID-19. Am J Transplant. 2020;20:1907–1910.
    1. Qin J, Wang H, Qin X, et al. Perioperative presentation of COVID-19 disease in a liver transplant recipient. Hepatology. [Epub ahead of print. March 27, 2020]. doi:10.1002/hep.31257
    1. Hoek RAS, Manintveld OC, Betjes MGH, et al. COVID-19 in solid organ transplant recipients: A single center experience. Transpl Int. [Epub ahead of print. May 27, 2020]. doi:10.1111/tri.13662
    1. Fernández-Ruiz M, Andrés A, Loinaz C, et al. COVID-19 in solid organ transplant recipients: a single-center case series from Spain. Am J Transplant. 2020;20:1849–1858.
    1. Tschopp J, L’Huillier AG, Mombelli M, et al.; Swiss Transplant Cohort Study (STCS). First experience of SARS-CoV-2 infections in solid organ transplant recipients in the Swiss Transplant Cohort Study. Am J Transplant. 2020;20:2876–2882.
    1. Yi SG, Rogers AW, Saharia A, et al. Early experience with COVID-19 and solid organ transplantation at a US high-volume transplant center. Transplantation. 2020;104:2208–2214.
    1. Verleden GM, Godinas L, Lorent N, et al. COVID-19 in lung transplant patients: a case series. Am J Transplant. [Epub ahead of print. July 13, 2020]. doi:10.1111/ajt.16212
    1. Lescure FX, Bouadma L, Nguyen D, et al. Clinical and virological data of the first cases of COVID-19 in Europe: a case series. Lancet Infect Dis. 2020;20:697–706.
    1. Kim D, Quinn J, Pinsky B, et al. Rates of co-infection between SARS-CoV-2 and other respiratory pathogens. JAMA. 2020;323:2085–2086.
    1. Fishman JA, Grossi PA. Novel coronavirus-19 (COVID-19) in the immunocompromised transplant recipient: #Flatteningthecurve. Am J Transplant. 2020;20:1765–1767.
    1. Siddiqi HK, Mehra MR. COVID-19 illness in native and immunosuppressed states: a clinical-therapeutic staging proposal. J Heart Lung Transplant. 2020;39:405–407.
    1. Verleden GM, Glanville AR, Lease ED, et al. Chronic lung allograft dysfunction: Definition, diagnostic criteria, and approaches to treatment-A consensus report from the Pulmonary Council of the ISHLT. J Heart Lung Transplant. 2019;38:493–503.
    1. Harris PA, Taylor R, Thielke R, et al. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42:377–381.
    1. Salehi S, Abedi A, Balakrishnan S, et al. Coronavirus disease 2019 (COVID-19): A systematic review of imaging findings in 919 patients. Am J Roentgenol. 2020;215:1–7.
    1. Levey AS, Eckardt KU, Dorman NM, et al. Nomenclature for kidney function and disease: report of a Kidney Disease: Improving Global Outcomes (KDIGO) Consensus Conference. Kidney Int. 2020;97:1117–1129.
    1. Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307:2526–2533.
    1. Section 2: AKI definition. Kidney Int Suppl. 2012;2:19–36.
    1. Simonnet A, Chetboun M, Poissy J, et al.; LICORN and the Lille COVID-19 and Obesity study group. High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring). 2020;28:1195–1199.
    1. Petrilli CM, Jones SA, Yang J, et al. Factors associated with hospital admission and critical illness among 5279 people with coronavirus disease 2019 in New York City: prospective cohort study. BMJ. 2020;369:m1966
    1. Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabolism. 2020;108:154262
    1. Ritschl PV, Nevermann N, Wiering L, et al. Solid organ transplantation programs facing lack of empiric evidence in the COVID-19 pandemic: A By-proxy Society Recommendation Consensus approach. Am J Transplant. 2020;20:1826–1836.
    1. 2020. Available at . Accessed June 27, 2020.
    1. Ahn C, Amer H, Anglicheau D, et al. Global transplantation COVID report March 2020. Transplantation. 2020;104:1974–1983.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera