(695) Predictors of Omicron Covid-19 Severity in a Large Lung Transplant Cohort

PURPOSE: Lung transplant recipients (LTR) are at higher risk of developing allograft dysfunction/serious illness following COVID-19 infection. A national lock-down, plus a multi-pronged prevention strategy started early in the COVID-19 pandemic saw only 12 (2%) LTR in our cohort become COVID-19 positive (COV+) till end of 2021. In 2022, end of compulsory lockdowns and the arrival of the omicron variant resulted in a further 204 (33%) LTR becoming COV+. This paper investigates predictors of COVID-19 severity and outcomes in a large LTR cohort. METHODS: Demographic, COVID treatment and outcome data on all COV+ LTR between Mar 2020- Sept 2022 were collected prospectively. LTR with higher NIH COVID-19 severity (score ≥ 3) were compared to lower severity using logistic regression. RESULTS: 216 from 650 LTR had 224 COV+ infections. Median age was 60yrs, 55% were male, 98% were bilateral LTR. Median time from LTx to COV+ was 5.2yrs (IQR 2.7-10). 193 (85%) had received ≥ 3 COVID vaccines and 38 (17%) evusheld. COVID treatment was commenced within 48hrs in 151 (70%). 42 (19%) COV+ LTR were hospitalized, 8 (4%) admitted to ICU. Only 13/216 (6%) LTR had a COVID severity score ≥ 3, however 8 /13 (62%) of these died- 5 deaths (at mean 11 days) due to COVID pneumonitis, 3 deaths (at mean 61 days), due to COVID complications. Results from logistic regression analysis to determine risk factors for COVID severity are displayed in Table 1. Predictors of COVID severity were increased BMI, chronic kidney disease stage 4/5, <3 vaccinations, and absence of treatment with remdesivir at time of COV+ diagnosis. Surprisingly, age and CLAD diagnosis did not predict a poor outcome. CONCLUSION: Vaccination prevention and remdesivir treatment proved potent omicron COVID management strategies. In an evolving COVID environment, rapid patient communication tools were critical to optimizing care. Less morbidity and mortality were seen than previously described. Patients with chronic kidney disease and obesity are a high risk cohort that should be targeted in future COVID-19 waves.