Impact of COVID-19 on Lung Allograft and Clinical Outcomes in Lung Transplant Recipients: A Case-Control Study.

Permpalung, Nitipong; Bazemore, Katrina; Chiang, Teresa Po-Yu; Mathew, Joby; Barker, Lindsay; Nematollahi, Saman; Cochran, Willa; Sait, Afrah S; Avery, Robin K; Shah, Pali D

BACKGROUND The impacts of COVID-19 on lung allograft function, rejection, secondary infection, and clinical outcomes in lung transplant recipients (LTRs) remain unknown. METHODS A 1:2 matched case-control study was performed to evaluate re-hospitalization, lung allograft function, and secondary infections up to 90 days after COVID-19 diagnosis (or index dates for controls). RESULTS Twenty-four LTRs with COVID-19 (cases) and 48 controls were identified. Cases and controls had similar baseline characteristics and lung allograft function. LTRs with COVID-19 had higher incidence of secondary bacterial infection (29.2% vs 6.3%, p = 0.008), readmission (29.2% vs 10.4%, p = 0.04), and for-cause bronchoscopy (33.3% vs 12.5%, p = 0.04) compared to controls. At day 90, mortality in cases vs controls was 8.3 vs 2.1% (p = 0.21), incidence of invasive fungal infections in cases vs controls was 20.8% vs 8.3% (p = 0.13) and forced expiratory volume in 1 second (FEV1) decline ≥ 10% from baseline occurred in 19% of cases vs 12.2% of controls (p= 0.46). No acute cellular rejection, acute antibody mediated rejection, or new donor specific anti-HLA antibodies were observed among cases or controls within 90 days post index date. CONCLUSIONS We found LTRs with COVID-19 were at risk to develop secondary infections and re-hospitalization post COVID-19, compared to controls. While we did not observe post -viral ACR or AMR, further studies are needed to understand if LTRs with COVID-19 who did not recover baseline lung function within 90 days have developed chronic lung allograft dysfunction stage progression.