COVID-19 puts lung transplant recipients at high risk regardless of vaccination status

NASHVILLE, Tenn. — Lung transplant recipients with COVID-19 appear to have increased risk for mortality and sustained lung function decline regardless of vaccination status, according to study results presented at the CHEST Annual Meeting.

“With the advent of the mRNA vaccine in 2020, we know that this led to less hospitalization, less disease progression, less risk of death,” Alan S. Nyquist, MD, advanced lung disease and lung transplant physician at Inova Fairfax Hospital in Falls Church, Virginia, said during the presentation. “However, even in our population of those who have been vaccinated, they’ve still succumbed to the virus.”

This retrospective study included 45 lung transplant recipients (mean age, 56.8 years; 51.5% women; mean time from transplant, 4.09 years) from Inova Fairfax Hospital who had documented COVID-19 from March 2020 to February 2022. Researchers collected data on transplant type, immunization, immunosuppression, cell-free DNA, spirometric data, hospitalization, death, infections and complications.

Of the 45 patients included in this study, 18 received a single lung transplant, 23 received bilateral transplants, one received a combined heart and lung transplant, and three received re-do transplants. In this cohort, 11 patients were unvaccinated, two were partially vaccinated, 11 were vaccinated but not boosted and 21 were both vaccinated and boosted.

Thirty-four patients required hospitalization and 19 patients received monoclonal antibodies, 10 of whom continued to require hospitalization. Among those who were hospitalized, seven were unvaccinated, one was partially vaccinated, 11 were vaccinated but not boosted and 15 were both vaccinated and boosted.

Eight patients who were hospitalized died during the study period. Among these patients, three were unvaccinated, one was partially vaccinated, one was vaccinated but not boosted and three were both vaccinated and boosted.

Seven patients who were hospitalized required intubation; six of these patients died while on ventilators. Of the 28 who were not intubated, two died due to COVID-19.

Regarding complications from hospitalization, six patients were readmitted within 30 days and one of these patients died. Three patients developed pneumocystis pneumonia, one developed empyema, one developed severe pseudomonas infection and one had reactivation of CMV after COVID-19 infection. Of the 25 patients with available spirometric data 2 weeks post-infection, 17 had an average FVC decline of 0.17 L and 14 had an average FEV₁ decline of 0.14 L. These results remained consistent when repeated with a further FVC decrease of 0.25 L in nine patients and a further FEV₁ decrease of 0.13 L in seven patients.

“COVID-19 represents a high-risk condition for lung transplant recipients regardless of their vaccination status, leading to hospitalization, death and loss of lung function,” Nyquist said. “In this population, we clearly need new algorithms for immunosuppression, monitoring and treatment for outcomes.”

Reference:

Nyquist AS, et al. Chest. 2022;doi:10.1016/j.chest.2022.08.2099.