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COVID-19 Has a High Mortality Rate in Lung Transplant Recipients: A Large Single-Center Experience

PURPOSE: Immunosuppressed patients, particularly solid organ transplant recipients, are at an increased risk of death from COVID-19. We report a large single-center experience with COVID-19 in lung transplant recipients (LTRs). METHODS: This is a retrospective cohort study of 91 LTRs diagnosed with...

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Autores principales: Razia, D., Omar, A., Grief, K., Walia, R., Tokman, S.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Published by Elsevier Inc. 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8988711/
http://dx.doi.org/10.1016/j.healun.2022.01.1216
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author Razia, D.
Omar, A.
Grief, K.
Walia, R.
Tokman, S.
author_facet Razia, D.
Omar, A.
Grief, K.
Walia, R.
Tokman, S.
author_sort Razia, D.
collection PubMed
description PURPOSE: Immunosuppressed patients, particularly solid organ transplant recipients, are at an increased risk of death from COVID-19. We report a large single-center experience with COVID-19 in lung transplant recipients (LTRs). METHODS: This is a retrospective cohort study of 91 LTRs diagnosed with COVID-19 between March 1, 2020 and August 31, 2021. Patients were classified as alive (n=61) or deceased (n=30). The Kruskal-Wallis and Chi-squared tests were used for data analysis. RESULTS: Mortality from COVID-19 was high (n=30, 33%). There was no difference in baseline clinical characteristics between alive and deceased patients; age, medical co-morbidities, body mass index, and lung function were similar (Table 1). The vast majority of patients were hospitalized (n=79, 86%), not only for severe illness but also to receive remdesivir, an infusion available only to inpatients. Patients that died were more commonly hypoxemic and admitted to the ICU, more likely to require mechanical ventilation, and had a longer hospital stay. Of the 24 intubated patients, only 4 survived (16.7%); 2 patients were placed on ECMO and both died. Deceased patients had higher peak levels of D-dimer, ferritin, procalcitonin, and lactate dehydrogenase. The vast majority of patients received corticosteroids; deceased patients were more likely to be treated with remdesivir and tocilizumab. Extrapulmonary complications were more common in deceased patients: 33% developed renal failure requiring hemodialysis and 19.2% developed multi-organ system dysfunction. The median time to death was 1.1 (0.63, 3.70) months; 3 patients survived the acute illness but died several months later of complications from post-adult respiratory distress syndrome-fibrosis. CONCLUSION: The COVID-19 pandemic has had catastrophic consequences for lung transplant recipients. We hope that high vaccination rates, reduction of immunosuppression in the early disease period, and more effective antiviral therapies can reduce mortality.
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spelling pubmed-89887112022-04-11 COVID-19 Has a High Mortality Rate in Lung Transplant Recipients: A Large Single-Center Experience Razia, D. Omar, A. Grief, K. Walia, R. Tokman, S. J Heart Lung Transplant (1196) PURPOSE: Immunosuppressed patients, particularly solid organ transplant recipients, are at an increased risk of death from COVID-19. We report a large single-center experience with COVID-19 in lung transplant recipients (LTRs). METHODS: This is a retrospective cohort study of 91 LTRs diagnosed with COVID-19 between March 1, 2020 and August 31, 2021. Patients were classified as alive (n=61) or deceased (n=30). The Kruskal-Wallis and Chi-squared tests were used for data analysis. RESULTS: Mortality from COVID-19 was high (n=30, 33%). There was no difference in baseline clinical characteristics between alive and deceased patients; age, medical co-morbidities, body mass index, and lung function were similar (Table 1). The vast majority of patients were hospitalized (n=79, 86%), not only for severe illness but also to receive remdesivir, an infusion available only to inpatients. Patients that died were more commonly hypoxemic and admitted to the ICU, more likely to require mechanical ventilation, and had a longer hospital stay. Of the 24 intubated patients, only 4 survived (16.7%); 2 patients were placed on ECMO and both died. Deceased patients had higher peak levels of D-dimer, ferritin, procalcitonin, and lactate dehydrogenase. The vast majority of patients received corticosteroids; deceased patients were more likely to be treated with remdesivir and tocilizumab. Extrapulmonary complications were more common in deceased patients: 33% developed renal failure requiring hemodialysis and 19.2% developed multi-organ system dysfunction. The median time to death was 1.1 (0.63, 3.70) months; 3 patients survived the acute illness but died several months later of complications from post-adult respiratory distress syndrome-fibrosis. CONCLUSION: The COVID-19 pandemic has had catastrophic consequences for lung transplant recipients. We hope that high vaccination rates, reduction of immunosuppression in the early disease period, and more effective antiviral therapies can reduce mortality. Published by Elsevier Inc. 2022-04 2022-04-07 /pmc/articles/PMC8988711/ http://dx.doi.org/10.1016/j.healun.2022.01.1216 Text en Copyright © 2022 Published by Elsevier Inc. Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.
spellingShingle (1196)
Razia, D.
Omar, A.
Grief, K.
Walia, R.
Tokman, S.
COVID-19 Has a High Mortality Rate in Lung Transplant Recipients: A Large Single-Center Experience
title COVID-19 Has a High Mortality Rate in Lung Transplant Recipients: A Large Single-Center Experience
title_full COVID-19 Has a High Mortality Rate in Lung Transplant Recipients: A Large Single-Center Experience
title_fullStr COVID-19 Has a High Mortality Rate in Lung Transplant Recipients: A Large Single-Center Experience
title_full_unstemmed COVID-19 Has a High Mortality Rate in Lung Transplant Recipients: A Large Single-Center Experience
title_short COVID-19 Has a High Mortality Rate in Lung Transplant Recipients: A Large Single-Center Experience
title_sort covid-19 has a high mortality rate in lung transplant recipients: a large single-center experience
topic (1196)
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8988711/
http://dx.doi.org/10.1016/j.healun.2022.01.1216
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