Short and mid-term outcomes of lung transplant recipients with COVID-19

Introduction: COVID-19 raises concerns for lung transplant recipients (LTX) due to the lung as a target organ in immunocompromised patients. Aims and objectives: Evaluating COVID-19 course, treatments received, radiological and functional evolution in LTX. Methods: We conducted a retrospective study of LTX with a PCR confirmed diagnosis of COVID-19. Results: 42 LTX were included from 18/03/2020 until 01/02/2021. Mean age was 54y (19-73), mean time after LTX 68mo (7-194). 30 (71%) LTX were hospitalised with a mean duration of 14d (1-41). Seven (17%) needed ICU, 5 (12%) endotracheal intubation and 1 (2%) VV ECMO. 4 (10%) died. From the 7 patients in ICU, 4 were aged>65y, 2 had diabetes, 2 hypertension, 2 BMI>30. In all hospitalised patients immunosuppression was adapted (mycophenolate mofetil withdrawn for at least 2 weeks, low level of calcineurin inhibitors, 5 day course of azithromycin 500mg). 8 (19%) received hydroxychloroquine, 8 (19%) remdesivir, 9 (21%) COVID-19 convalescent plasma and 9 (21%) higher corticosteroid dose. 4 (10%) LTX experienced recurrent COVID-19. 3 (7%) developed acute rejection shortly after COVID-19. In LTX with follow-up chest CT (n=15) minimal sequellae were described. Mean decrease in FEV1 compared to baseline at 1, 3 and 6 months was, respectively, -133mL (IQR -190 to 35, n=28), -176mL (IQR -330 to 75, n=16) and -48mL (IQR -140 to 90, n=11). No patient met criteria for onset of CLAD. Conclusions: We found a higher mortality and more severe disease course in LTX than in the healthy population. Recurrence of COVID-19 is a frequent event. At mid-term, we did not observe significant new incidence of CLAD onset. Treatment of COVID-19 and risk of CLAD after COVID-19 in LTX require further studies.