Short and Intermediate Term Effects of COVID-19 Infection on Lung Transplant Recipients

PURPOSE: The characteristics and outcomes, including acute cellular rejection (ACR), of lung transplant recipients (LTR) post COVID-19 infection are incompletely studied. We sought to show whether or not COVID-19 infection in LTR is associated with ACR. METHODS: This single center, retrospective study of LTR examined data among those who contracted COVID-19 between June 2020 and May 2021. Patient demographics, immunosuppression regimen, and hospital course related to COVID-19 infection were recorded. Subsequent spirometry, imaging, and biopsy results were documented. RESULTS: We identified 16 LTR who tested positive for COVID by PCR testing. Acute radiographic changes were detected in half (8) of the cohort, 3 patients eventually required ICU admission, 1 which required venovenous extracorporeal membrane oxygenation. The median drop in FEV1 and FVC after COVID-19 infection was -375 (-1140 to +120) and -260mL (-1790 to +410), respectively. ACR was diagnosed in 2 patients at 6 weeks post COVID-19 infection. Both of the patients who were diagnosed with ACR required hospitalization, and one required ICU admission. There was 1 death at >6 months after infection due to progressive chronic lung allograft dysfunction and renal failure. CONCLUSION: This analysis characterizes short and intermediate term outcomes of LTR after COVID-19 infection. Specifically, the association between such infection and both rates of ACR and allograft function is uniquely described. ACR was observed in 12.5% of patients 6 weeks post COVID-19 infection. There was a notable reduction in lung function, which was mostly accounted for by the 3 patients in our cohort who required ICU admission. This study has several limitations. The sample size is small and involves a single center. It is also retrospective in nature, and there were a large number of asymptomatic patients included. Further analyses, to further assess the incidence of ACR in LTR are warranted to determine the associated factors and optimize management in this at risk patient population.