tetano
Editor, Senior Moderator
Transpl Infect Dis
. 2021 Oct 4.
doi: 10.1111/tid.13739. Online ahead of print.
Post-infection pulmonary sequelae after COVID-19 among patients with lung transplantation
Luke D Mahan[SUP] 1 [/SUP], Isaac Lill[SUP] 1 [/SUP], Quinn Halverson[SUP] 1 [/SUP], Manish R Mohanka[SUP] 1 [/SUP], Adrian Lawrence[SUP] 1 [/SUP], John Joerns[SUP] 1 [/SUP], Srinivas Bollineni[SUP] 1 [/SUP], Vaidehi Kaza[SUP] 1 [/SUP], Ricardo M La Hoz[SUP] 2 [/SUP], Song Zhang[SUP] 3 [/SUP], Corey D Kershaw[SUP] 1 [/SUP], Lance S Terada[SUP] 1 [/SUP], Fernando Torres[SUP] 1 [/SUP], Amit Banga[SUP] 1 [/SUP]
Affiliations
Abstract
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 FEV[SUB]1[/SUB] 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 X10[SUP]3[/SUP] /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.
Keywords: CLAD; COVID survivors; SARS-CoV-2; allograft dysfunction; predictors; survival.
. 2021 Oct 4.
doi: 10.1111/tid.13739. Online ahead of print.
Post-infection pulmonary sequelae after COVID-19 among patients with lung transplantation
Luke D Mahan[SUP] 1 [/SUP], Isaac Lill[SUP] 1 [/SUP], Quinn Halverson[SUP] 1 [/SUP], Manish R Mohanka[SUP] 1 [/SUP], Adrian Lawrence[SUP] 1 [/SUP], John Joerns[SUP] 1 [/SUP], Srinivas Bollineni[SUP] 1 [/SUP], Vaidehi Kaza[SUP] 1 [/SUP], Ricardo M La Hoz[SUP] 2 [/SUP], Song Zhang[SUP] 3 [/SUP], Corey D Kershaw[SUP] 1 [/SUP], Lance S Terada[SUP] 1 [/SUP], Fernando Torres[SUP] 1 [/SUP], Amit Banga[SUP] 1 [/SUP]
Affiliations
- PMID: 34605596
- DOI: 10.1111/tid.13739
Abstract
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 FEV[SUB]1[/SUB] 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 X10[SUP]3[/SUP] /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.
Keywords: CLAD; COVID survivors; SARS-CoV-2; allograft dysfunction; predictors; survival.