COVID-19 in lung transplant recipients: A single center case series from New York City

Abstract

There are limited data describing COVID‐19 in lung transplant recipients. We performed a single center, retrospective case series study of lung transplant patients followed by the Columbia Lung Transplant program who tested positive for SARS‐CoV‐2 between March 19 and May 19, 2020. Thirty‐two lung transplant patients developed mild (16%), moderate (44%), or severe (41%) COVID‐19. The median age of patients was 65 years, and the median time from lung transplant was 5.6 years. Symptoms included cough (66%), dyspnea (50%), fever (47%), and gastrointestinal upset (44%). Patients received hydroxychloroquine (84%), azithromycin (75%), augmented steroids (44%), tocilizumab (19%), and remdesivir (9%). Eleven patients (34%) died at a median time of 14 days from admission. Complications during admission included: acute kidney injury (63%), transaminitis (31%), shock (31%), acute respiratory distress syndrome (25%), neurological events (25%), arrhythmias (22%), and venous thromboembolism (9%). Compared to patients with moderate COVID‐19, patients with severe COVID‐19 had higher peak white blood cell counts (15.8 vs 7 × 103/uL, P = .019), C‐reactive protein (198 vs. 107 mg/L, P = .010) and D‐dimer (8.6 vs. 2.1 ug/mL, P = .004) levels, and lower nadir lymphocyte counts (0.09 vs. 0.4 × 103/uL, P = .006). COVID‐19 is associated with severe illness and a high mortality rate in lung transplant recipients.

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

“…The hospital outcomes in the largest case series from Spain were poor, with more than 80% of the patients developing respiratory failure and nearly 40% succumbing to the infection. Similarly, in New York, 34% of the LT patients with COVID-19 succumbed within 2 weeks of illness [18], while the mortality rate was 25% in a series from Philadelphia [17]. Conversely, the outcomes from the Belgian series [20] appeared to be better, although it included only 10 patients.…”

Impact of COVID-19 in solid organ transplant recipients

“…The presentation of SOT recipients with COVID‐19 appears similar to the general population. Fever (61–83%), cough (45–75%), and diarrhea (22–57%) were the most common symptoms reported 14‐16,71,75,79,80,83‐88 . Abnormalities in chest imaging occurred frequently; cohorts of SOT recipients in New York City reported abnormal chest radiographs in 96%–100% 83,84 .…”

“…Across all organ types, acute kidney injury (AKI) was reported in 20%–70% of hospitalized patients 73,80,85,86,89,96 . In comparison to non‐transplant patients admitted for COVID‐19, statistically significant increases in AKI during hospitalization were reported in SOT recipients (20% vs. 5%) with a trend to statistical significance in another SOT cohort being compared to critically ill non‐transplant patients (37% vs. 27%) 86,96 .…”

“…Mortality ranged from 9 to 46% with most in the 18–30% range depending on the cohort and circumstances 14,15,17,33,72,73,75,77‐79,83‐85,88,89,91,94,95,103,104 . All‐cause mortality during the study period of the UK registry reached 26% for SOT recipients and 10% for those on the waitlist, although local utilization decisions related to resource availability may have impacted these numbers 74 .…”

Immunogenicity of BNT162b2 mRNA COVID-19 vaccine and SARS-CoV-2 infection in lung transplant recipients

“…Lung Transplant Recipients (LTRs) are among the most vulnerable groups in the COVID-19 pandemic (mortality 14-39%). [1][2][3][4] An early report provided evidence of a poor antibody response after the first mRNA vaccine dose in solid organ transplant recipients. 5 However, the immunogenicity of the novel mRNA COVID-19 complete 2-dose vaccine in LTRs is unknown to date.…”