Nitipong Permpalung1, Katrina Bazemore, Teresa Po-Yu Chiang, Joby Mathew, Lindsay Barker, Saman Nematollahi, Willa Cochran, Afrah S Sait, Robin K Avery, Pali D Shah. 1. Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA Division of Mycology, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand Division of Pulmonary and Critical Care, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, USA Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, USA.
Abstract
BACKGROUND: The impacts of COVID-19 on lung allograft function, rejection, secondary infection, and clinical outcomes in lung transplant recipients (LTRs) remain unknown. METHODS: A 1:2 matched case-control study was performed to evaluate re-hospitalization, lung allograft function, and secondary infections up to 90 days after COVID-19 diagnosis (or index dates for controls). RESULTS: Twenty-four LTRs with COVID-19 (cases) and 48 controls were identified. Cases and controls had similar baseline characteristics and lung allograft function. LTRs with COVID-19 had higher incidence of secondary bacterial infection (29.2% vs 6.3%, p = 0.008), readmission (29.2% vs 10.4%, p = 0.04), and for-cause bronchoscopy (33.3% vs 12.5%, p = 0.04) compared to controls. At day 90, mortality in cases vs controls was 8.3 vs 2.1% (p = 0.21), incidence of invasive fungal infections in cases vs controls was 20.8% vs 8.3% (p = 0.13) and forced expiratory volume in 1 second (FEV1) decline ≥ 10% from baseline occurred in 19% of cases vs 12.2% of controls (p= 0.46). No acute cellular rejection, acute antibody mediated rejection, or new donor specific anti-HLA antibodies were observed among cases or controls within 90 days post index date. CONCLUSIONS: We found LTRs with COVID-19 were at risk to develop secondary infections and re-hospitalization post COVID-19, compared to controls. While we did not observe post -viral ACR or AMR, further studies are needed to understand if LTRs with COVID-19 who did not recover baseline lung function within 90 days have developed chronic lung allograft dysfunction stage progression.
BACKGROUND: The impacts of COVID-19 on lung allograft function, rejection, secondary infection, and clinical outcomes in lung transplant recipients (LTRs) remain unknown. METHODS: A 1:2 matched case-control study was performed to evaluate re-hospitalization, lung allograft function, and secondary infections up to 90 days after COVID-19 diagnosis (or index dates for controls). RESULTS: Twenty-four LTRs with COVID-19 (cases) and 48 controls were identified. Cases and controls had similar baseline characteristics and lung allograft function. LTRs with COVID-19 had higher incidence of secondary bacterial infection (29.2% vs 6.3%, p = 0.008), readmission (29.2% vs 10.4%, p = 0.04), and for-cause bronchoscopy (33.3% vs 12.5%, p = 0.04) compared to controls. At day 90, mortality in cases vs controls was 8.3 vs 2.1% (p = 0.21), incidence of invasive fungal infections in cases vs controls was 20.8% vs 8.3% (p = 0.13) and forced expiratory volume in 1 second (FEV1) decline ≥ 10% from baseline occurred in 19% of cases vs 12.2% of controls (p= 0.46). No acute cellular rejection, acute antibody mediated rejection, or new donor specific anti-HLA antibodies were observed among cases or controls within 90 days post index date. CONCLUSIONS: We found LTRs with COVID-19 were at risk to develop secondary infections and re-hospitalization post COVID-19, compared to controls. While we did not observe post -viral ACR or AMR, further studies are needed to understand if LTRs with COVID-19 who did not recover baseline lung function within 90 days have developed chronic lung allograft dysfunction stage progression.
Authors: Jesper M Magnusson; Hillevi Larsson; Ahmed Alsaleh; Jan Ekelund; Kristjan Karason; Andreas Schult; Vanda Friman; Marie Felldin; John Mackay Søfteland; Göran Dellgren; Mihai Oltean Journal: Transpl Int Date: 2021-11-14 Impact factor: 3.842
Authors: Kemarut Laothamatas; Jamie Hum; Luke Benvenuto; Lori Shah; Harpreet Singh Grewal; Marcus Pereira; Jenna Scheffert; Maggie Carroll; Margaret Nolan; Genevieve Reilly; Philippe Lemaitre; Bryan P Stanifer; Joshua R Sonett; Frank D'Ovidio; Hilary Robbins; Selim M Arcasoy Journal: Transplant Direct Date: 2022-02-21
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