Lung transplant recipients remain at high risk for severe disease, mortality from omicron variant

Despite a lower overall mortality rate, lung transplant recipients remain at high risk for severe disease and death from the COVID-19 omicron variant compared with both the general population and other respiratory infections.

“[The omicron variant] is shown to be associated with lower severity of illness in the general population, particularly among the vaccinated, compared to the preceding variants,” Jamie Hum, DNP, lung transplant nurse practitioner in the division of pulmonary and critical care medicine and with the Lung Transplant Program at NewYork-Presbyterian/Columbia University Irving Medical Center, and colleagues wrote in Annals of the American Thoracic Society. “... However, early data in solid organ transplant recipients continue to indicate higher severity of illness and mortality among lung transplant recipients.”

Hum and colleagues conducted a retrospective cohort study of 98 consecutive lung transplant recipients (median age, 58 years; 51% men) from the Lung Transplant Program at the Columbia University Irving Medical Center. All had a positive SARS-CoV-2 diagnosis from Dec. 19, 2021, to Jan. 31, 2022. Those with mild disease did not require hospitalization, those with moderate disease required hospitalization and those with severe disease were admitted to the ICU or stepdown unit or required non-rebreather mask, high-flow nasal cannula, noninvasive ventilation or mechanical ventilation.

Researchers treated patients with mild symptoms and an oxygen saturation of more than 94% with monoclonal antibodies and/or oral antivirals. For those with an oxygen saturation less than 94% who were on room air and/or required supplemental oxygen, researchers administered dexamethasone 6 mg daily or corticosteroids for 10 days or until hospital discharge. Patients with hypoxemia were given remdesivir (Veklury, Gilead Sciences) within 10 days of COVID-19 symptom onset.

All patients were followed until death or the end of the study period in April 2022. Researchers compared results from this omicron cohort with those of the first-surge (n = 32) and second-surge (n = 47) cohorts at their institution.

In the omicron cohort, 14% had a history of COVID-19 and, of these, 71% had received their initial vaccines plus a booster, 14% received initial vaccines only and 14% were not vaccinated. In the overall cohort, 11% of patients were not vaccinated. Regarding COVID-19 severity, 60% of patients had mild, 26% had moderate and 14% had severe disease.

The 90-day mortality rate was 12% in the overall cohort compared with 34% in the first-surge cohort and 17% in the second-surge cohort. Compared with the earlier COVID-19 cohorts, the omicron cohort had a lower proportion of severe disease (14%, third surge vs. 41%, first surge; 28%, second surge) and hospitalization (39%, third surge vs. 84%, first surge; 66%, second surge).

“Despite the lower mortality rate in this cohort of lung transplant recipients infected by [the] SARS-CoV-2 omicron variant compared to the two prior COVID-19 cohorts at our center, COVID-19 continues to cause significant morbidity and mortality,” the researchers wrote.