Dataset Information

A Single-center Experience With >200 Lung Transplant Recipients With COVID-19 Infection.

ABSTRACT:

Background

Although COVID-19 is no longer a declared global health emergency, data remain limited on the impact of COVID-19 in lung transplant recipients.

Methods

We identified lung transplant recipients who were diagnosed with COVID-19 from March 2020 through August 2022 in our institutional database and investigated clinical outcomes. We then analyzed outcomes based on date of COVID-19 diagnosis (first wave March 2020-October 2020; second wave November 2020-2021; third wave December 2021-September 2022) and compared these results.

Results

Of the 210 lung transplant recipients (median age 67; 67% men) enrolled, 140 (67%) required hospital admission. Among admitted recipients, 35 (25%) were intubated and 7 (5%) were placed on extracorporeal membrane oxygenation. Overall survival was 67.1% at 1 y and 59.0% at 2 y post-COVID-19 diagnosis. COVID-19 led to mortality in all 5 patients diagnosed during their index admission for lung transplantation. Although overall survival was significantly better in recipients with COVID-19 during the third wave, in-hospital mortality remained high (first wave 28%, second wave 38%, and 28% third wave). Vaccination (partially vaccinated versus none and fully vaccinated versus none) was the only significant protective factor for hospital admission, and age 70 y and older and partially vaccinated (versus none or fully vaccinated) were independent risk factors for in-hospital mortality.

Conclusions

Overall survival after COVID-19 infection in lung transplant recipients continues to improve; however, in-hospital mortality remains remarkably high. Vaccination appears to have been impactful in preventing hospital admission, but its impact on in-hospital mortality is still unclear. Further research is needed to better identify lung transplant recipients at high risk for mortality from COVID-19.

SUBMITTER: Kehara H

PROVIDER: S-EPMC11365680 | biostudies-literature | 2024 Sep

REPOSITORIES: biostudies-literature

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Publications

A Single-center Experience With >200 Lung Transplant Recipients With COVID-19 Infection.

Kehara Hiromu H Johnson-Whiting Ashley A Yanagida Roh R Krishan Kewal K Zhao Huaqing H Mishkin Aaron A Cordova Francis F Criner Gerard J GJ Toyoda Yoshiya Y Shigemura Norihisa N

Transplantation direct 20240829 9

<h4>Background</h4>Although COVID-19 is no longer a declared global health emergency, data remain limited on the impact of COVID-19 in lung transplant recipients.<h4>Methods</h4>We identified lung transplant recipients who were diagnosed with COVID-19 from March 2020 through August 2022 in our institutional database and investigated clinical outcomes. We then analyzed outcomes based on date of COVID-19 diagnosis (first wave March 2020-October 2020; second wave November 2020-2021; third wave Dece ...[more]

PMID: 39220217

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Project description:BackgroundAlthough coronavirus disease 2019 (COVID-19) is no longer classified as a Public Health Emergency of International Concern by World Health Organization, its global impact persists. Data on its impact in lung transplant recipients (LTRs) from China remain limited. This study aims to share clinical experiences and provide insights into managing LTRs with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.MethodsWe conducted a study on LTRs with COVID-19 caused by the Omicron variant from November 17, 2022, to May 1, 2023. Clinical information was gathered retrospectively through electronic medical records, questionnaires, or follow-up telephone calls.ResultsA total of 227 LTRs were reviewed for infection with Omicron variant. After excluding 49 cases without confirmed SARS-CoV-2 infection, this left a final cohort of 178 infected LTRs, accounting for an infection rate of 78.4% (178/227). Of the patients, 50% (89/178) required hospitalization, with an average hospital stay of 16 days [interquartile range (IQR): 9.5-25.5 days]. Of the 89 hospitalized patients, 41.6% (37/89) eventually progressed to severe or critical disease, forming the severe/critical group (S/C group), while the remaining 58.4% (52/89) had mild or moderate disease (M/M group). In comparison to the M/M group, the S/C group had higher C-reactive protein (CRP) (59.6 vs. 16.8 mg/L, P<0.001), Erythrocyte sedimentation rate (45.5 vs. 22.5 mm/h, P=0.005) and D-dimer level (1.09 vs. 0.65 mg/L, P=0.01), but lower CD4+ T lymphocytes count (217 vs. 427 cells/µL, P=0.004). The S/C group had significantly higher rates of combined pulmonary bacterial infection (67.6% vs. 38.5%, P=0.006) and pulmonary fungal infection (73.0% vs. 38.5%, P=0.001) during the course of COVID-19, nearly double that of the M/M group. In a multivariate logistic analysis, elevated CRP (>41.8 mg/L), combined pulmonary fungal infection, and interstitial lung disease (ILD) as primary disease emerged as high-risk factors for developing the severe disease phenotype following Omicron variant infection in LTRs, with respective odds ORs values of 4.23 [95% confidence interval (CI): 1.68-11.23], 4.76 (95% CI: 1.59-15.64), and 5.13 (95% CI: 1.19-29.17). Receiver operating characteristic (ROC) curve analysis showed that CD4+ T lymphocyte count may be a strong marker for predicting death. At a cutoff of 404 cells/µL, sensitivity was 0.509, specificity 0.999, and area under the curve (AUC) was 0.806 (95% CI: 0.678-0.934). Ultimately, 13 recipients succumbed to COVID-19 related respiratory failure or secondary multiple organ dysfunction, resulting in an overall mortality rate of 7.3% (13/178).ConclusionsLTRs are at high risk of secondary lung infections after Omicron. Key risk factors for severe disease include CRP >41.8 mg/L, ILD as primary disease, and pulmonary fungal infection. CD4+ T lymphocyte count may predict mortality risk in LTRs with COVID-19.

Project description:Rationale & objectiveThe world is facing a global pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although kidney transplant recipients are at increased risk for viral infections, the impact of their chronic immunosuppressed status on the risk for acquiring coronavirus disease 2019 (COVID-19) and disease severity is unknown.Study designAll cases of COVID-19 infection in our cohort of kidney transplant recipients were prospectively monitored. Clinical features, management, and outcomes were recorded. A standard strategy of immunosuppression minimization was applied: discontinue the antimetabolite drug and reduce trough levels of calcineurin or mammalian target of rapamycin inhibitors. Unless contraindicated, hydroxychloroquine was administered only to hospitalized patients.Setting & participants22 COVID-19 infections were diagnosed in our cohort of 1,200 kidney transplant recipients.ResultsMost common initial symptoms included fever, cough, or dyspnea. 18 (82%) patients required hospitalization. Of those patients, 3 had everolimus-based immunosuppression. Computed tomography of the chest at admission (performed in 15 patients) showed mild (n = 3), moderate (n = 8), extensive (n = 1), severe (n = 2), and critical (n = 1) involvement. Immunosuppression reduction was initiated in all patients. Hydroxychloroquine was administered to 15 patients. 11 patients required supplemental oxygen; 2 of them were admitted to an intensive care unit (ICU) with mechanical ventilation. After a median of 10 days, 13 kidney transplant recipients were discharged, 2 were hospitalized in non-ICU units, 1 was in the ICU, and 2 patients had died.LimitationsSmall sample size and short follow-up.ConclusionsThe clinical presentation of COVID-19 infection was similar to that reported in the general population. A standard strategy of immunosuppression minimization and treatment was applied, with 11% mortality among kidney transplant recipients hospitalized with COVID-19 infection.

Dataset Information

A Single-center Experience With >200 Lung Transplant Recipients With COVID-19 Infection.

Background

Methods

Results

Conclusions

Publications

A Single-center Experience With >200 Lung Transplant Recipients With COVID-19 Infection.

Similar Datasets

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