COVID-19 Has a High Mortality Rate in Lung Transplant Recipients: A Large Single-Center Experience

Abstract

PurposeImmunosuppressed patients, particularly solid organ transplant recipients, are at an increased risk of death from COVID-19. We report a large single-center experience with COVID-19 in lung transplant recipients (LTRs).MethodsThis is a retrospective cohort study of 91 LTRs diagnosed with COVID-19 between March 1, 2020 and August 31, 2021. Patients were classified as alive (n=61) or deceased (n=30). The Kruskal-Wallis and Chi-squared tests were used for data analysis.ResultsMortality from COVID-19 was high (n=30, 33%). There was no difference in baseline clinical characteristics between alive and deceased patients; age, medical co-morbidities, body mass index, and lung function were similar (Table 1). The vast majority of patients were hospitalized (n=79, 86%), not only for severe illness but also to receive remdesivir, an infusion available only to inpatients. Patients that died were more commonly hypoxemic and admitted to the ICU, more likely to require mechanical ventilation, and had a longer hospital stay. Of the 24 intubated patients, only 4 survived (16.7%); 2 patients were placed on ECMO and both died. Deceased patients had higher peak levels of D-dimer, ferritin, procalcitonin, and lactate dehydrogenase. The vast majority of patients received corticosteroids; deceased patients were more likely to be treated with remdesivir and tocilizumab. Extrapulmonary complications were more common in deceased patients: 33% developed renal failure requiring hemodialysis and 19.2% developed multi-organ system dysfunction. The median time to death was 1.1 (0.63, 3.70) months; 3 patients survived the acute illness but died several months later of complications from post-adult respiratory distress syndrome-fibrosis.ConclusionThe COVID-19 pandemic has had catastrophic consequences for lung transplant recipients. We hope that high vaccination rates, reduction of immunosuppression in the early disease period, and more effective antiviral therapies can reduce mortality.