COVID‐19 in lung transplant recipients: A single center case series from New York City

Aversa, Meghan; Benvenuto, Luke; Anderson, Michaela; Shah, Lori; Robbins, Hilary; Pereira, Marcus; Scheffert, Jenna; Carroll, Maggie; Hum, Jamie; Nolan, Margaret; Reilly, Genevieve; Lemaitre, Philippe; Stanifer, B. Payne; D’Ovidio, Frank; Sonett, Joshua; Arcasoy, Selim

There are limited data describing COVID‐19 in lung transplant recipients. We performed a single center, retrospective case series study of lung transplant patients followed by the Columbia Lung Transplant program who tested positive for SARS‐CoV‐2 between March 19‐May 19, 2020. 32 lung transplant patients developed mild (16%), moderate (44%), or severe (41%) COVID‐19. The median age of patients was 65 years, and the median time from lung transplant was 5.6 years. Symptoms included cough (66%), dyspnea (50%), fever (47%), and gastrointestinal upset (44%). Patients received hydroxychloroquine (84%), azithromycin (75%), augmented steroids (44%), tocilizumab (19%), and remdesivir (9%). 11 patients (34%) died at a median time of 14 days from admission. Complications during admission included: acute kidney injury (63%), transaminitis (31%), shock (31%), acute respiratory distress syndrome (25%), neurological events (25%), arrhythmias (22%), and venous thromboembolism (9%). Compared to patients with moderate COVID‐19, patients with severe COVID‐19 had higher peak white blood cell counts (15.8 vs. 7 x 10(3)/uL, p=0.019), C‐reactive protein (198 vs. 107 mg/L, p=0.010) and D‐dimer (8.6 vs. 2.1 ug/mL, p=0.004) levels, and lower nadir lymphocyte counts (0.09 vs. 0.4x 10(3)/uL, p=0.006). COVID‐19 is associated with severe illness and a high mortality rate in lung transplant recipients.