COVID-Related Chronic Allograft Dysfunction in Lung Transplant Recipients: Long-Term Follow-up Results from Infections Occurring in the Pre-vaccination Era

• Published in: Transplantology (Basel, Switzerland) Vol. 3; no. 4; pp. 275 - 282
• Main Authors: Hage, René, Schuurmans, Macé M.
• Format: Journal Article
• Language: English
• Published: Birmingham MDPI AG 01.12.2022
• Subjects: Antigens; chronic lung allograft dysfunction; Chronic obstructive pulmonary disease; CLAD hypothesis; community-acquired respiratory viral infection; Coronaviruses; COVID-19; Creatinine; Cystic fibrosis; Infections; Lung diseases; Lung transplants; Severe acute respiratory syndrome coronavirus 2; Spirometry; Viral infections
• ISSN: 2673-3943; 2673-3943
• DOI: 10.3390/transplantology3040028

Introduction: We report on characteristics and lung function outcomes among lung transplant recipients (LTRs) after COVID-19 with infections occurring in the first year of the coronavirus pandemic prior to introduction of the vaccines. Methods: This was a retrospective study of 18 LTRs who tested positive for SARS-CoV-2 between 1 February 2020 and 1 March 2021. The mean age was 49.9 (22–68) years; 12 patients (67%) were male. Two patients died due to severe COVID-19. Results: During the study period, there were 18 lung transplant recipients with a community-acquired SARS-CoV-2 infection. In this cohort, seven had mild, nine had moderate, and two had severe COVID-19. All patients with mild and moderate COVID-19 survived, but the two patients with severe COVID-19 died in the intensive care unit while intubated and on mechanical ventilation. Most patients with moderate COVID-19 showed a permanent lung function decrease that did not improve after 12 months. Conclusion: A majority of LTRs in the current cohort did not experience an alteration in the trajectory of FEV1 evolution after developing SARS-CoV-2 infection. However, in the patients with moderate COVID-19, most patients had a decline in the FEV1 that was present after 1 month after recovery and did not improve or even deteriorated further after 12 months. In LTRs, COVID-19 can have long-lasting effects on pulmonary function. Treatment strategies that influence this trajectory are needed.