One Year Into the Pandemic: Evolving COVID-19 Outcomes in Lung Transplant Recipients, a Single-center Experience

Abstract

In the early months of the coronavirus disease 2019 (COVID-19) pandemic, our center reported a mortality rate of 34% in a cohort of 32 lung transplant recipients with COVID-19 between March and May 2020. Since then, there has been evolving knowledge in prevention and treatments of COVID-19. To evaluate the impact of these changes, we describe the clinical presentation, management, and outcomes of a more recent cohort of lung transplant recipients during the second surge and provide a comparison with our first cohort.

Methods: We conducted a retrospective cohort study that included all consecutive lung transplant recipients who tested positive for severe acute respiratory syndrome coronavirus 2 between November 2020 and February 28, 2021. We compared baseline demographics and major outcomes between the first- and second-surge cohorts.

Results: We identified 47 lung transplant recipients (median age, 60; 51% female) who tested positive for severe acute respiratory syndrome coronavirus 2 between November 2020 and February 28, 2021. The current cohort had a higher proportion of patients with mild disease (34% versus 16%) and fewer patients with a history of obesity (4% versus 25%). Sixty-six percent (n = 31) required hospitalization and were treated with remdesivir (90%) and dexamethasone (84%). Among those hospitalized, 77% (n = 24) required supplemental oxygen, and 22% (n = 7) required invasive mechanical ventilation. The overall 90-d mortality decreased from 34% to 17% from the first cohort to the second (adjusted odds ratio, 0.26; 95% confidence interval, 0.08-0.85; P = 0.026).

Conclusions: Although COVID-19-associated mortality rate in lung transplant recipients at our center has decreased over time, COVID-19 continues to be associated with significant morbidity and mortality.

FIGURE 1.

A, Kaplan-Meier Plot of the probability of survival from COVID-19 diagnosis to day 90 in lung transplant recipients with COVID-19 from the first and second surges. There was a trend toward reduced 90-d mortality in the second-surge cohort in both unadjusted and adjusted analyses (17% vs 34%; adjusted OR, 0.26; 95% CI, 0.08-0.85; P = 0.026). B, Kaplan-Meier Plot of the probability of survival from COVID-19 diagnosis to day 90 in lung transplant recipients with moderate-to-severe COVID-19 from the first and second surges. There was a trend toward reduced 90-d mortality in the second-surge cohort of patients with moderate-to-severe COVID-19 in unadjusted and adjusted analyses (26% vs 41%; adjusted OR, 0.28; 95% CI, 0.79-1.03; P = 0.056). CI, confidence interval; COVID-19, coronavirus disease 2019; OR, odds ratio.