A Multicenter Prospective Registry Study of Lung Transplant Recipients Hospitalized with COVID-19

Heldman, M. R.; Kates, O. S.; Multani, A.; Steinbrink, J. M.; Lewis, A. V.; Alexander, B. D.; Beaird, O. E.; Sehgal, S.; Mishkin, A. D.; La Hoz, R. M.; Blumberg, E. A.; Nelson, J.; Safa, K.; Kotton, C. N.; Hemmersbach-Miller, M.; Chaudhry, Z. S.; Saharia, K.; Morillas, J. A.; Rakita, R. M.; Sait, A. S.; Meloni, F.; Wilkens, H.; Camargo, P.; Tanna, S. D.; Tomic, R.; Ison, M. G.; Lease, E. D.; Fisher, C. E.; Limaye, A. P.

Purpose Outcomes of lung transplant recipients (LTR) hospitalized for COVID-19 and comparisons to non-lung solid organ transplant recipients (SOTR) are incompletely described. Methods Using a multicenter prospective registry of SOTR, we examined 28-day outcomes (mortality [primary outcome], intensive care unit (ICU) admission, mechanical ventilation, and bacterial pneumonia) among both LTR and non-lung SOTR hospitalized with laboratory-confirmed COVID-19 diagnosed between March 1, 2020 and September 21, 2020. Data were analyzed using Stata (StataCorp, College Station, TX); chi-square tests were used to compare categorical variables and multivariable logistic regression was used to assess risk factors for mortality. Results The cohort included 72 LTR and 392 non-lung SOTR (Table 1). Overall, 28-day mortality trended higher in LTR vs. non-lung SOTR (27.8% vs. 19.9%, P=0.136). Other 28-day outcomes were similar between LTR and non-lung SOTR: ICU admission (45.8% vs. 39.1%, P=0.28), mechanical ventilation (32.9% vs. 31.1%, P=0.78), and bacterial pneumonia (15.3% vs. 8.2%, P=0.063). Congestive heart failure, diabetes, age >65 years, and obesity (BMI >= 30) were independently associated with mortality in non-lung SOTR, but not in LTR (Table 2). Conclusion In this large prospective cohort comparing lung and non-lung SOTR hospitalized for COVID-19, there were high but not significantly different rates of short-term morbidity and mortality. Baseline comorbidities appeared to drive mortality in non-lung SOTR but not LTR. Further studies are needed to identify risk factors for mortality among LTR.