Kehara Hiromu, Johnson-Whiting Ashley, Yanagida Roh, Krishan Kewal, Zhao Huaqing, Mishkin Aaron, Cordova Francis, Criner Gerard J, Toyoda Yoshiya, Shigemura Norihisa
Division of Cardiovascular Surgery, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
Department of Biomedical Education and Data Science, Center for Biostatistics and Epidemiology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA.
Transplant Direct. 2024 Aug 29;10(9):e1676. doi: 10.1097/TXD.0000000000001676. eCollection 2024 Sep.
Although COVID-19 is no longer a declared global health emergency, data remain limited on the impact of COVID-19 in lung transplant recipients.
We identified lung transplant recipients who were diagnosed with COVID-19 from March 2020 through August 2022 in our institutional database and investigated clinical outcomes. We then analyzed outcomes based on date of COVID-19 diagnosis (first wave March 2020-October 2020; second wave November 2020-2021; third wave December 2021-September 2022) and compared these results.
Of the 210 lung transplant recipients (median age 67; 67% men) enrolled, 140 (67%) required hospital admission. Among admitted recipients, 35 (25%) were intubated and 7 (5%) were placed on extracorporeal membrane oxygenation. Overall survival was 67.1% at 1 y and 59.0% at 2 y post-COVID-19 diagnosis. COVID-19 led to mortality in all 5 patients diagnosed during their index admission for lung transplantation. Although overall survival was significantly better in recipients with COVID-19 during the third wave, in-hospital mortality remained high (first wave 28%, second wave 38%, and 28% third wave). Vaccination (partially vaccinated versus none and fully vaccinated versus none) was the only significant protective factor for hospital admission, and age 70 y and older and partially vaccinated (versus none or fully vaccinated) were independent risk factors for in-hospital mortality.
Overall survival after COVID-19 infection in lung transplant recipients continues to improve; however, in-hospital mortality remains remarkably high. Vaccination appears to have been impactful in preventing hospital admission, but its impact on in-hospital mortality is still unclear. Further research is needed to better identify lung transplant recipients at high risk for mortality from COVID-19.
尽管新冠病毒病（COVID-19）不再被宣布为全球卫生紧急事件，但关于COVID-19对肺移植受者影响的数据仍然有限。
我们在机构数据库中识别出2020年3月至2022年8月期间被诊断为COVID-19的肺移植受者，并调查临床结局。然后我们根据COVID-19诊断日期（第一波：2020年3月至10月；第二波：2020年11月至2021年；第三波：2021年12月至2022年9月）分析结局并比较这些结果。
在纳入的210例肺移植受者（中位年龄67岁；67%为男性）中，140例（67%）需要住院治疗。在住院的受者中，35例（25%）接受了气管插管，7例（5%）接受了体外膜肺氧合治疗。COVID-19诊断后1年的总生存率为67.1%，2年为59.0%。COVID-19导致所有5例在肺移植初次住院期间被诊断出的患者死亡。尽管第三波期间感染COVID-19的受者总体生存率显著更好，但住院死亡率仍然很高（第一波28%，第二波38%，第三波28%）。接种疫苗（部分接种与未接种以及完全接种与未接种相比）是住院的唯一显著保护因素，70岁及以上且部分接种（与未接种或完全接种相比）是住院死亡的独立危险因素。
肺移植受者感染COVID-19后的总体生存率持续改善；然而，住院死亡率仍然非常高。接种疫苗似乎对预防住院有影响，但其对住院死亡率的影响仍不清楚。需要进一步研究以更好地识别COVID-19死亡高风险的肺移植受者。
