COVID-19 in Lung-Transplant Recipients: A Descriptive Study

Abstract

PurposeTransplant recipients are more susceptible to infection, however the medical literature lacks sufficient data regarding COVID-19 post transplantation, especially in lung-transplant recipients. This population appears to be at higher risk for critical illness due to comorbidities and chronic immunosuppressive stateMethodsThis was a single-center, retrospective study of 7 lung-transplant recipients who were symptomatic and tested positive for COVID-19 between Feb 2020 and Oct 2020. Demographics, including single vs double lung transplantation, time from transplant were included. Laboratory data on admission, immunosuppressive regimen and adjustment during hospitalization, oxygen requirements and outcomes were also collectedResultsTo date, 7 out of 227 post-lung transplant patients followed at our center became symptomatic with COVID-19 infection. The average age was 60.5 years and 70% were female. All patients had double lung transplantation performed between Apr 2010 and Nov 2019. The average body mass index was 27.0 kg/m2. 85% required hospitalization, three had to be admitted to the intensive care unit, two required invasive mechanical ventilation. Two patients died (one due to acute kidney injury and refractory shock and one refused intubation). One patient on mechanical ventilation required VV ECMO 3 days after admission as a bridge to recovery. All patients were on standard triple immunosuppressive regimen [tacrolimus, mycophenolate, and prednisone]. Mycophenolate was stopped for all patients at the time of the infection, and those who required oxygen supplementation (n=5) received dexamethasone and convalescent plasma. Two of them were not eligible for Remdesivir. Elevated d-dimer (0.78 - 5.57 mg/L), LDH (253 - 985 U/L) and the degree of hypoxemia on admission correlated to worse outcomesConclusionCOVID-19 infection in lung transplant patients has a variable course. In our study, d-dimer, LDH and the degree of hypoxemia on admission had a linear correlation with unfavorable outcome, similar to what has been reported for non lung-transplant patients with COVID-19. Intubation and mechanical ventilation portend a poor prognosis. In our cohort reduction in net immunosuppression (stopping anti-metabolite) and supportive treatment was utilized. Prevention remains the best intervention for COVID-19