COVID-19 in Recent Lung Transplant Recipients: Clinical Outcomes and Management Strategies

Abstract

Background: COVID-19 causes a wide range of symptoms, with particularly high risk of severe respiratory failure and death in patients with predisposing risk factors such as advanced age or obesity. Recipients of solid organ transplants, and in particular lung transplantation, are more susceptible to viral infection owing to immune suppressive medication. As little is known about the SARS-CoV-2 infection in these patients, this study was undertaken to describe outcomes and potential management strategies in early COVID-19 infection early after lung transplantation.

Methods: We describe the incidence and outcome of COVID-19 in a cohort of recent lung transplant recipients in Munich. Six of 186 patients who underwent lung transplantation in the period between March 2019 and March 2021 developed COVID-19 within the first year after transplantation. We documented the clinical course and laboratory changes for all patients showing differences in the severity of the infection with COVID-19 and their outcomes.

Results: Three of 6 SARS-CoV-2 infections were hospital-acquired and the patients were still in inpatient treatment after lung transplantation. All patients suffered from symptoms. One patient did not receive antiviral therapy. Remdesivir was prescribed in 4 patients and the remaining patient received remdesivir, bamlanivimab and convalescent plasma.

Conclusions: COVID-19 does not appear to cause milder disease in lung transplant recipients compared with the general population. Immunosuppression is potentially responsible for the delayed formation of antibodies and their premature loss. Several comorbidities and a general poor preoperative condition showed an extended hospital stay.

Fig 1

rRT-PCR ct-values and anti-SARS-CoV-2-antibodies in detail for each patient (Patients A-F). ct-Values are shown as black dots, connected by a trend line. No anti-SARS-CoV-2-antibodies represented by a red Y and anti-SARS-CoV-2-antibodies as a green Y. X-axis represents days; day 1 started after the first positive rRT-PCR. Y-axis shows the ct-values. ct-values ≥35 represents noninfectious patients. rRT-PCR, real-time reverse-transcriptase-polymerase chain reaction.

Fig 2

Patient A. Axial high-resolution CT scan of a mild SARS-CoV-2 infection. Left: Images 10 days after diagnosis; bilaterally moderate patchy ground glass opacities in the bases. Right: 73 days after the first negative rRT-PCR test. Almost complete recovery of the lung parenchyma. rRT-PCR, real-time reverse-transcriptase-polymerase chain reaction. CT, computed tomography.

Fig 3

Patient B. Axial high-resolution CT scan of a severe SARS-CoV-2 infection. Course from top left to bottom right. Seven days after diagnosis and on day 37, 69, 90, 102, and 111 (11 days before death). Initial CT scan almost inconspicuous (top left); ground glass opacities, consolidation, and bacterial superinfection are shown in the following images. CT, computed tomography.

Fig 4

Individual course of a mild infection (patient A) from lung transplantation to discharge. The diagram is based on a timeline including rRT-PCR ct-values represented in black dots, which are connected by a trendline. The presence of anti-SARS-CoV-2-antibodies is shown as green Y's, and no anti-SARS-CoV-2-antibodies are marked by red Y's. Medical treatment is shown above the curve and symptoms as well as other special events under the curve and on the x-axis. The green background color describes the pre- or post-infection period and red the infection. rRT-PCR, real-time reverse-transcriptase-polymerase chain reaction.

Fig 5

Individual course of a severe infection (patient B) from lung transplantation to death. The diagram is based on a timeline including rRT-PCR ct-values represented in black dots, which are connected by a trendline. The presence of anti-SARS-CoV-2-antibodies is shown as green Y's, and no anti-SARS-CoV-2-antibodies are marked by red Y's. Medical treatment is shown above the curve and symptoms as well as other special events under the curve and on the x-axis. The green background color describes the pre-infection period and red the infection. rRT-PCR, real-time reverse-transcriptase-polymerase chain reaction.