Obese Lung Recipients May Be Susceptible to Severe COVID-19 Outcomes Compared to Controls

PURPOSE: Obesity is thought to increase COVID-19 (C19) related morbidity and mortality in nontransplant patients; however, the data in lung transplant literature are lacking. We aimed to study impact of body mass index (BMI) on outcomes of lung transplant recipients (LTR) with C19. METHODS: From March 2020 to August 2021, 91 lung recipients with C19 were included and classified as controls (BMI <30 kg/m(2)) and obese (BMI ≥30 kg/m(2)) at the time of LT listing. Primary outcome was death. Secondary outcome was C19-related medical morbidity. Cox proportional hazard analysis and Kaplan-Meier method were used. RESULTS: Controls (69%, n=63) and obese (31%, n=28) subjects were comparable in terms of baseline characteristics before C19 onset. Compared to controls, obese subjects tended to have more severe inflammation and a higher prevalence of hypoxemia, requirement of ICU, mechanical ventilation, and death (Table 1). Also compared to controls, the risk of death tended to be higher and probability of survival tended to be lower in obese subjects (HR: 1.971 [0.956-4.065], p=0.066 and 73% vs 53.6%, p=0.061, respectively; Figure 1). However, coinfections and post-C19 allograft function were comparable between the two groups (Table 1). Of note, mycophenolate was stopped or reduced upon/during hospitalization in both groups alike. CONCLUSION: In our study, obese LTRs trended toward an increased risk of death from C19 compared to controls. This is the first data on the impact of obesity on C19 in LTRs. The role of leptin as a pro-inflammatory substance can be speculated.