COVID-19 in lung transplant recipients: an overview of the Swedish national experience

Abstract

Although it is known that solid organ transplant recipients fare worse after COVID-19 infection, data on the impact of COVID-19 on clinical outcomes and allograft function in lung transplant (LTx) recipients are limited and based mainly on reports with short follow-up. In this nationwide study, all LTx recipients with COVID-19 diagnosed from 1 February 2020 to 30 April 2021 were included. The patients were followed until 1 August 2021 or death. We analysed demographics, clinical features, therapeutic management and outcomes, including lung function. Forty-seven patients were identified: median age was 59 (10-78) years, 53.1% were male, and median follow-up was 194 (23-509) days. COVID-19 was asymptomatic or mild at presentation in 48.9%. Nine patients (19.1%) were vaccinated pre-COVID infection. Two patients (4.3%) died within 28 days of testing positive, and the overall survival rate was 85.1%. The patients with asymptomatic or mild symptoms had a higher median % expected forced expiratory volume during the first second than the patients with worse symptoms (P = 0.004). LTx recipients develop the entire spectrum of COVID-19, and in addition to previously acknowledged risk factors, lower pre-COVID lung function was associated with more severe disease presentation.

Keywords: COVID-19; lung function; lung transplantation; multicentre study; severity; survival.

Figure 1

Cumulative incidence of mortality on disease severity. Incidence is presented with confidence intervals. Below the graph, patients at risk at corresponding time points, are presented.

Figure 2

∆FEV1 PRE–POST COVID‐19. Spirometric difference between last spirometry before COVID and follow‐up spirometries for mild vs moderate or worse symptomatology. Number of spirometries in each group are for 0–30: 12/8, for 31–90: 16/14 and for 91–280: 12/15.