(696) Low Covid-19 Related Mortality Among Lung Transplant Recipients at a Single Center

PURPOSE: The omicron variant era led to a dramatic increase in COVID-19 infection in lung transplant recipients (LTR). We previously described our experience with COVID-19 in LTR during the wild type and delta variant eras. Here we provide an update on short and intermediate term outcomes of COVID-19 infections in LTR. METHODS: This is a single-center retrospective study of all LTR at the University of California San Diego with COVID-19 infections between June 2020 and September 2022. Patient demographic data, immunosuppression regimen, and hospital course were recorded. Subsequent spirometry, imaging, biopsy results and interventions were also obtained (Table 1). RESULTS: 72 LTR with PCR-confirmed COVID-19 infection were included. 45 (62.5%) were male, 39 (54.2%) were Caucasian, and 56 (77.8%) had double-LT. 56 (73.6%) had symptomatic infections, 27 (37.5%) required hospitalization, including 7 (9.7%) requiring ICU admission and 1 (1.4%) requiring extracorporeal membrane oxygenation. The median drop in FEV1 and FVC at 3 months was 2.4% and 2.5%, respectively. Post-infection ACR and death were seen in 3 (4.2%) patients. Of the 3 deaths, 2 were due to COVID-19 infection in LTRs with stage 3 chronic lung allograft dysfunction (CLAD). The remaining death was related to failure to thrive and occurred months after COVID infection. CONCLUSION: The omicron era of COVID-19 led to a nearly 5-fold increase in COVID-19 infections among LTR. Despite the higher prevalence of COVID-19 infection, the mortality in our cohort remained low compared to other published reports of COVID-19 infection in LTR. Compared to our prior analysis which included only wild type and delta variant eras, the rates of mortality and ACR both decreased from 11.8% to 4.2%. This improvement in post COVID-19 outcomes may be attributable to monoclonal antibody therapy, increased vaccination, pre exposure prophylaxis and changes in viral virulence. Larger studies are needed to assess the impact of the various COVID-19 variants on LTRs.