COVID-19 Disease in Lung Transplant Recipients: A Case Series

Purpose Lung transplant (LTx) recipients may be at increased risk for fulminant novel SARS-CoV-2 COVID-19 infection due to their immunosuppressed state. Additional risk factors, outcomes, and optimal management of COVID-19 in LTx recipients is unknown. Methods We identified LTx recipients infected with COVID-19 by nasopharyngeal swab in our institution. Baseline demographics and clinical data were obtained through review of the electronic medical record (EMR) from 3/20/2020 to 10/25/2020. Results Ten LTx recipients were diagnosed with COVID-19 infection. Disease course and management details are described in Table 1. Mean age was 57.5 ± 8 years, 50% were women (n = 5), and 70% self-identified as Latinx, 66% had a high school diploma or lower education. Medicare or Medicaid was the primary insurance in 60% (n = 6). Mean household size was 3.2 ± 1.5 persons. Forty percent (n = 4) had mild symptoms that progressed to fulminant hypoxemic respiratory failure at 9-10 days from symptom onset. Ninety percent (n = 9) required hospitalization with an average length of stay 14.8 ± 12. Sixty percent (n = 6) were treated in the intensive care unit (ICU), 40% (n = 4) requiring mechanical ventilation. COVID-19 specific therapies included remdesivir (80%, n = 8), dexamethasone (60%, n = 6), and convalescent plasma (50%, n = 5). Mycophenolate mofetil (MMF) was reduced or held in 60% (n = 6) of recipients. One recipient who recovered later died in hospice care from other comorbidities. Conclusion Most LTx recipients infected with COVID-19 had severe complications, with a high proportion requiring ICU admission and mechanical ventilation. Though, mortality was relatively low. Adjustments to immunosuppression included reduction in MMF and steroid augmentation. Similar to the general US population, there is a disproportionate impact of COVID-19 infection in Latinx LTx recipients that may be related to social factors such as residing in multi-generational households.