Sars-CoV-2 Infection in Lung Transplant Patients - Single Center Experience in Portugal

Introduction Lung transplant (LT) patients are immunosuppressed and it is yet to be determined if immunosuppression plays a role in SARS-CoV-2 infection. Due to this lack of information about COVID-19 in solid transplant patients, case series are of utmost importance. We report two cases of LT patients with COVID-19 at our LT center. Case Report We report a 60-year-old man submitted to a bilateral LT due to COPD in January 2020. Immunosuppression: basiliximab as induction and prednisolone, mycophenolate mofetil and tacrolimus as maintenance therapy. He was discharged 47 days post-operatively. Six months after LT, as routine screening to an elective endoscopy for previously controlled Barret's esophagus, RT-PCR of naso-pharyngeal swabs detected SARS-CoV-2 RNA, assuming the diagnosis of COVID-19. He was hospitalized for monitoring despite being asymptomatic. Oxygen saturation was always higher than 97% at room air. Leukocyte was 5.730 × 10^9/L (lymphopenia 530 × 10^9/L), D-dimer 1913 ug/L, C-reactive protein (CRP) 51,1 mg/l, ferritin 163,7 ng/mL and lactate dehydrogenase (LDH) 370 units/L. CT-scan excluded thromboembolism and active infection. He remain asymptomatic and was discharged. The second case was a 54-year-old man submitted to a bilateral LT due to COPD in June 2020. Immunosuppression: basiliximab as induction and prednisolone, mycophenolate mofetil and tacrolimus as maintenance therapy. He was discharged 76 days post-operatively due to post-infection anastomosis stenosis. Three months after LT, as routine screening to a bronchofibroscopy for revaluation of stenosis, RT-PCR naso-pharyngeal swabs detected SARS-CoV-2 RNA, assuming the diagnosis of COVID-19. He revealed more dyspnea (mMRC 2) and cough than usual, with no other symptoms. Oxygen saturation was always higher than 96% at room air. Leukocyte 7.560 × 10^9/L, CRP 41,5 mg/l, LDH 566 units/L. He stayed at home in isolation with mild symptoms that improved in one week to his previous health status. Both patients had no travel history and no known contact with SARS-CoV2-2 infected patient. Summary We report 2 cases among a total of 174 LT patients in follow‐up at our center (1,1%), we underline that SARS-CoV-2 infection can present itself with mild or no symptoms in LT patients that theoretically are more vulnerable. Also we reinforce the importance of routine screening of these patients before any procedure.