(705) Risk Factors for Death and Hospitalisation in COVID-19 Infection in Lung Transplant Recipients; a Single Australian Centre Experience

PURPOSE: Rates of hospitalisation and death from COVID-19 in lung transplant recipients vary. We aimed to assess risk factors for hospitalisation and death in an Australian cohort of predominantly vaccinated recipients after COVID-19. METHODS: A retrospective cohort study of all LTx recipients between Jan 2020-Sep 2022 with COVID-19 was performed. Baseline recipient characteristics and treatments were recorded. Multivariate logistic regression was performed to identify risk factors associated with hospitalisation and death. RESULTS: 128/387 (33%) recipients tested positive to SARS-CoV-2 during the study period, 97.6% during the Omicron waves. 40(31.3%) required hospitalisation and 10 (7.8%) died. The median (IQR) recipient age was 50.6 (22-77) with median time post-transplant 1522 (17 - 9842) days. The cohort had high vaccination rates (98.4%), were Caucasian ethnicity 105 (82%), 48% were female. CLAD was present in 48 (37.5%). 103 (80.5%) received early COVID-19 treatment with Sotrovimab 84(65%), Molnupirivir 50(39%) or in combination 31(24%). 25(19%) received no early treatment. All hospitalised patients received Remdesivir and Dexamethasone as per local treatment protocols. Regarding risk of hospitalisation, multivariate analysis showed recipient age (1-unit change OR 1.04 95%CI 1.01-1.07 p=0.019) was associated with an increased risk, where Molnupiravir was protective (OR 0.32 95%CI 0.13-0.80 p=0.02). There were weak positive associations between non-Caucasian ethnicity and protective associations with Sotrovimab and need for hospitalisation. In univariable analysis increasing age (1-unit change, OR 1.07 95%CI 1.02-1.129 p=0.01) and severe disease (OR 9.95 95%CI 2.58-38.32 p=<0.001) were associated with an increased risk of death. Male gender, non-Caucasian ethnicity, CLAD, CKD stage 3-5 were correlated with death with weak association. CONCLUSION: Recipient age is a significant risk for both hospitalisation and death. Older patients with COVID-19 should be monitored closely during COVID-19 illness. Molnupirivir is protective against hospitalisation, with Sotrovimab having a weak association. Further analysis of the protective effect of pre-exposure prophylaxis with new therapies such as Evusheld would be helpful to fully evaluate the currently available early disease therapies in Australia.