COVID-19 in lung transplant recipients-Risk prediction and outcomes

Abstract

Patients after lung transplantation are at risk for life-threatening infections. Recently, several publications on COVID-19 outcomes in this patient population appeared, but knowledge on optimal treatment, mortality, outcomes, and appropriate risk predictors is limited. A retrospective analysis was performed in a German high-volume lung transplant center between 19th March 2020 and 18th May 2021. Impact of COVID-19 on physical and psychological health, clinical outcomes, and mortality were analyzed including follow-up visits up to 12 weeks after infection in survivors. Predictive parameters on survival were assessed using univariate and multivariate proportional hazards regression models. Out of 1,046 patients in follow-up, 31 acquired COVID-19 during the pandemic. 12 of 31 (39%) died and 26 (84%) were hospitalized. In survivors a significant decline in exercise capacity (p = 0.034), TLC (p = 0.02), and DLCO (p = 0.007) was observed at follow-up after 3 months. Anxiety, depression, and self-assessed quality of life remained stable. Charlson comorbidity index predicted mortality (HR 1.5, 1.1-2.2; p = 0.023). In recipients with pre-existing CLAD, mortality and clinical outcomes were inferior. However, pre-existing CLAD did not predict mortality. COVID-19 remains a life-threatening disease for lung transplant recipients, particularly in case comorbidities. Further studies on long term outcomes and impact on pre-existing CLAD are needed.

Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1. Flow chart.

SARS-CoV2, severe acute respiratory syndrome coronavirus 2.

Fig 2. Survival after COVID-19.

Kaplan-Meier survival estimate on 31 lung transplant recipients with confirmed SARS-CoV-2 infection.

Fig 3. Incidence of SARS-CoV-2 infections in Germany.

COVID-19 Pandemic subsumes the incidence in the German general population; COVID-19 Tx subsumes all confirmed SARS-CoV-2 infections in lung transplant recipients from our institution; those who deceased are shown black.

Fig 4. Chest computed tomography findings pre and post COVID-19.

Presentation of a 54-year-old male lung transplant recipient with pre-existing mixed phenotype chronic lung allograft dysfunction. A, B: High-resolution computed tomography (HR-CT) 4 months prior to COVID-19 infection. Axial slice showing distinct pleuroparenchymal infiltrates on the left side (arrow) and coronal slice showing streak densities in the basal parts of the lung as mild signs of CLAD. C, D: Axial HR-CT obtained 2 weeks after survived infection showing areas auf consolidation (arrows) mixed with ground glass opacities (arrow head). Images prior to COVID-19 were generated on a multidetector CT according to a standard protocol using a 64-row scanner (GE Lightspeed VCT, GE Healthcare, Chalfont St. Giles, United Kingdom). Either 100 kVp or 120 kVp tube voltage was used adjusted to the body mass index of the patient. Briefly, we used a detector collimation of 64 0.625 mm and a reconstructed slice thickness of 1.25 mm. High resolution CT images following COVID-19 were generated on a dual source 2x96-row MDCT (Siemens FORCE, Siemens Healthineers, Forchheim, Germany) (detector collimation: 192x0.7 mm, slice thickness: 1 mm, interval: 0.7 mm) and reconstructed in an appropriate kernel. COVID-19, Coronavirus disease 2019; CLAD, chronic lung allograft dysfunction; CT, computed tomography.