Evolving impact of the COVID-19 pandemic on lung transplant recipients: A single-center experience

Abstract

Lung transplant recipients (LTRs) are at increased risk of COVID-19-related morbidity and mortality; however, the disease severity has changed as SARS-CoV-2 variants have mutated. We compared COVID-19-related clinical outcomes in LTRs at different stages of the pandemic. We also identified risk factors for the development of severe COVID-19 independent of the dominant SARS-CoV-2 variant. This is a single-center, retrospective cohort study of LTRs with COVID-19. Cox regression analyses and bootstrapping were used to identify factors affecting COVID-19 severity. Between March 2020 and August 2022, 195 LTRs were diagnosed with COVID-19, almost half (89 [45.6%]) during the Omicron period. A total of 113 (58.5%) LTRs were hospitalized and 47 (24.1%) died. Age >65 years increased the risk of hospitalization and death. Although infection with the Omicron variant was associated with a lower risk of hospitalization, the median length of hospital stay (10 days, [IQR, 5- 19]) was similar between the variants. Intensive care unit (ICU) admission and death were more common with the Delta variant, but comparable between the original, Alpha, and Omicron variants. Remdesivir or molnupiravir reduced the risk of hospitalization, and monoclonal antibody therapy reduced the risk of ICU admission, intubation, and death. Vaccination and pre-exposure prophylaxis (PrEP) with tixagevimab-cilgavimab did not significantly reduce COVID-19-related ICU admission, intubation, or mortality among LTRs. LTRs with COVID-19 continue to have high hospitalization rates and prolonged hospital stays, despite reduced virulence of the Omicron variant. More effective PrEP and therapeutic interventions for COVID-19 among vulnerable patient groups are needed.