Clinical characteristics, management practices, and outcomes among lung transplant patients with COVID-19

Mohanka, Manish; Mahan, Luke D.; Joerns, John; Lawrence, Adrian; Bollineni, Srinivas; Kaza, Vaidehi; Hoz, Ricardo M. La; Kershaw, Corey D.; Terada, Lance S.; Torres, Fernando; Banga, Amit

doi:10.1016/j.healun.2021.05.003

Cited by 22 publications

(30 citation statements)

References 33 publications

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“…Interestingly, chronic kidney disease at their initial presentation was associated with deterioration of allograft function. 23 In another study, LTR had higher incidence of secondary bacterial infection (29.2% vs. 6.3%, P = .008) and readmission (29.2% vs. 10.4%, P = .04) compared with controls. 24 Need for hospitalization after acute COVID-19 was lower in our cohort (15.9%), as well as for hospital readmissions (27%).…”

Section: Discussionmentioning

confidence: 89%

“…According to the recent report of Mohanka et al., a significant proportion of lung transplant recipients (LTR) with COVID‐19 required readmission for worsening lung allograft function (36.4%). Interestingly, chronic kidney disease at their initial presentation was associated with deterioration of allograft function 23 . In another study, LTR had higher incidence of secondary bacterial infection (29.2% vs. 6.3%, P = .008) and readmission (29.2% vs. 10.4%, P = .04) compared with controls 24 .…”

Section: Discussionmentioning

confidence: 96%

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Hospitalization and death after recovery from acute COVID‐19 among renal transplant recipients

Nikolina

Sanjin

Ivana

et al. 2022

Clinical Transplantation

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Introduction: Data on post-COVID-19 in renal transplant recipients (RTR) is scarce.We investigated the rate of hospitalizations, reasons for hospital admission, and mortality rate among RTR who survived acute COVID-19.Methods: A multi-center retrospective observational cohort study measured hospital admission and death to 180 days after acute SARS-CoV-2 infection in 308 adult patients. Results:The median age was 57 years, 64.9% were male. All patients had at least one comorbidity, and 26.3% had diabetes. Data on post-COVID-19 course was available for 267 patients, and 49 of them (15.9%) required hospital treatment after recovery from the acute infection. The most common indications included pneumonia (24.5%) and renal allograft dysfunction (22.4%), 7 (14.3%) had sepsis and 5 (10.2%) had thrombotic events. A median duration of the hospital stay was 12 days. Six patients (2.2%) died due to multiorgan failure, respiratory insufficiency or urosepsis. The strongest predictor for hospitalization after acute COVID-19 was hospitalization for acute SARS-CoV-2 infection, while better allograft function decreased the probability of hospitalization. Conclusion:Delayed consequences of acute COVID-19 are highly prevalent and the health care systems should be prepared to respond to the needs of RTR suffering from post-COVID-19 complications.

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Section: Discussionmentioning

confidence: 89%

Section: Discussionmentioning

confidence: 96%

Hospitalization and death after recovery from acute COVID‐19 among renal transplant recipients

Nikolina

Sanjin

Ivana

et al. 2022

Clinical Transplantation

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“…The study period was extended to the last week of August 2021, which ensured that all the vaccinated patients were within 6 months of being vaccinated. A large proportion of the patients were admitted to the hospital given the proactive management protocols 10 and monitoring for the sudden deterioration that sometimes occurs among these patients.…”

Section: Discussionmentioning

confidence: 99%

“…The protocol for testing for SARS-CoV-2 was preformulated and has been described previously. 10,11 While patients underwent screening tests before any procedure or admission to the hospital for other indication per the institutional protocols, no LT patient was diagnosed with COVID-19 in that scenario.…”

Section: Methodsmentioning

confidence: 99%

“…The management protocols for COVID‐19 were devised at the onset of the pandemic based on the best available evidence, expert guidance, and consensus among the members of the lung transplant team, although with updates as more data became available. Various management strategies, including the details regarding indications for hospitalization, have been described previously 10 …”

Section: Methodsmentioning

confidence: 99%

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Characteristics and outcomes among vaccinated lung transplant patients with breakthrough COVID‐19

Bollineni

Mahan

Duncan

et al. 2022

Transplant Infectious Dis

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Background: Despite multiple studies evaluating the immunological responsiveness to vaccines, the clinical effectiveness of the two-dose mRNA vaccine schedule among lung transplant (LT) patients has not been evaluated. Methods:We included LT patients who tested positive for SARS-CoV-2 on a nasopharyngeal swab between March 1, 2020, and August 25, 2021 (n = 70). The study group was divided based on their vaccination status.Results: During the study period, 14 fully vaccinated LT patients with one of the mRNA vaccines tested positive for COVID-19 (median age 54, range 30-62 years, M:F 9:5).The vaccinated cohort was younger with bilateral LT, have suppurative conditions as the transplant indication, and present with milder symptoms. However, pulmonary parenchymal involvement was seen among all 12 patients where computed tomography (CT) of chest was available. The laboratory profile indicated a more subdued inflammatory response among the vaccinated group.A lower proportion of vaccinated patients developed respiratory failure, needed ICU admission or ventilator support, although none of the differences achieved statistical significance. None of the vaccinated patients succumbed to COVID-19 during the study period, while the 4-week mortality among unvaccinated patients was nearly 15% (8/56). Conclusions:In this cohort of vaccinated LT patients who developed breakthrough COVID-19, the clinical course, risk of complications, and outcomes trended better than unvaccinated patients. However, universal involvement of the allograft demonstrates the continued vulnerability of these patients to significant sequelae from COVID-19.Future studies may evaluate the incremental protection of vaccination after the completion of the third dose of mRNA vaccines among LT patients.

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Serological findings following the second and third SARS‐CoV‐2 vaccines in lung transplant recipients

Bárczi

Varga

Nagy

et al. 2022

Immunity Inflam & Disease

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Introduction Lung transplant recipients (LuTX) represent a vulnerable population for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Even though many vaccines are already developed, more clinical data need to support effective immunological response in immunocompromised patients. Methods Stable LuTX recipients with no medical history of coronavirus disease (COVID‐19) were enrolled. Currently available messenger RNA (mRNA) (BNT162b2‐mRNA, mRNA‐1273) and non‐mRNA (ChAdOx1, BBIBP‐CorV) vaccines were given according to availability, boosters were all mRNA‐based. SARS‐CoV‐2 Spike1 immunoglobulin G (IgG) antibody titer was evaluated before and 2 weeks after second and third dose. Difference between mRNA versus non‐mRNA vaccines was assessed. RESULTS Forty‐one patients (49% men, age 48.4 ± 13.8 years) received two doses of SARS‐CoV‐2 vaccines: 23 of mRNA, 18 of non‐mRNA, and 24/41 (58%) received a third dose. Median 92 months passed since transplantation, and serum level of tacrolimus was median 5.5 ng/ml. Positive serology was found in 37% of all patients after the second dose, 86% had mRNA vaccine. After the third dose, 29% became positive who had no antibody before. Significantly higher level of antibody was found after the second mRNA than non‐mRNA vaccines (2.2 vs. 1568.8 U/ml, respectively, p = .002). 6/23 (26%) patients received two doses of mRNA vaccine developed COVID‐19 after the second injection in an average of 178 days, half of them recovered, half of them died in intensive care unit (ICU). 3/6 (50%) patients with two doses mRNA and recovered from COVID‐19 had significantly higher level of antibody (average 20847.3 U/ml) than without infection. After the booster vaccine, 1/24 (4%) developed infection. Conclusion Immunosuppression therapy may induce a weaker SARS‐CoV‐2 response in LuTX recipients; therefore, third dose is a priority in transplanted patients. The highest antibody level was measured recovering from COVID after two doses. Our data confirm that booster mRNA vaccine could increase antibody levels, even if immunization was started with non‐mRNA vaccine.

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Clinical characteristics, management practices, and outcomes among lung transplant patients with COVID-19

Cited by 22 publications

References 33 publications

Hospitalization and death after recovery from acute COVID‐19 among renal transplant recipients

Hospitalization and death after recovery from acute COVID‐19 among renal transplant recipients

Characteristics and outcomes among vaccinated lung transplant patients with breakthrough COVID‐19

Serological findings following the second and third SARS‐CoV‐2 vaccines in lung transplant recipients

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