Post-infection pulmonary sequelae after COVID-19 among patients with lung transplantation

Mahan, Luke D; Lill, Isaac; Halverson, Quinn; Mohanka, Manish R; Lawrence, Adrian; Joerns, John; Bollineni, Srinivas; Kaza, Vaidehi; La Hoz, Ricardo M; Zhang, Song; Kershaw, Corey D; Terada, Lance S; Torres, Fernando; Banga, Amit

BACKGROUND: There is limited data on outcomes among lung transplant (LT) patients who survive Coronavirus disease 2019 (COVID-19). METHODS: Any single or bilateral LT patients who tested positive for SARS-CoV-2 between March 1, 2020, to February 15, 2021 (n=54) and survived the acute illness were included (final n=44). Each patient completed at least three months of follow-up (median: 4.5; range 3-12 months) after their index hospitalization for COVID-19. The primary endpoint was a significant loss of lung functions (defined as >10% decline in FVC or FEV1 on two spirometries, at least three weeks apart compared to the pre-infection baseline). RESULTS: A majority of the COVID-19 survivors had persistent parenchymal opacities (n=29, 65.9%) on post-infection CT chest. Patients had significantly impaired functional status, with the majority reporting residual disabilities (Karnofsky performance scale score of 70% or worse; n=32, 72.7%). A significant loss of lung function was observed among 18 patients (40.9%). Three patients met the criteria for new chronic lung allograft dysfunction (CLAD) following COVID-19 (5.6%), with all three demonstrating restrictive allograft syndrome phenotype. An absolute lymphocyte count <0.6 X103 /dL and ferritin >150 ng/mL at the time of hospital discharge were independently associated with significant lung function loss. CONCLUSIONS: A significant proportion of COVID-19 survivors suffer persistent allograft injury. A persistently low ALC and elevated ferritin at the conclusion of the hospital course may provide useful prognostic information and form the basis of a customized strategy for ongoing monitoring and management of allograft dysfunction. TWEET: Twitter handle: @AmitBangaMD This article is protected by copyright. All rights reserved.