ORIGINAL RESEARCH article
Front. Transplant.
Sec. Thoracic Transplantation
Volume 4 - 2025 | doi: 10.3389/frtra.2025.1583919
This article is part of the Research TopicManaging COVID-19 in Heart and Lung Transplant Patients: Challenges and SolutionsView all 3 articles
Long-Term Outcomes of a Case-Control Lung Transplant Cohort after SARS-CoV-2 Infection
Provisionally accepted
Sandrine Hanna1*
Rami Hallak1,2
Susanna M Leonard3,4Samantha Morrison5
Sarah Peskoe5Jordan Whitson1
John Reynolds1
Cameron Robert Wolfe1Hakim Azfar Ali1*- 1Duke University Medical Center, Duke University, Durham, United States
- 2Baptist Health Paducah, Paducah, United States
- 3Duke University Hospital, Durham, North Carolina, United States
- 4University of Pennsylvania, Philadelphia, Pennsylvania, United States
- 5School of Medicine, Duke University, Durham, North Carolina, United States
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Abstract:Background: Respiratory viruses can impact the allograft function in lung transplant recipients, but it is unknown if this occurs with SARS-CoV-2 infection. We studied the long-term outcomes of lung transplant recipients infected with SARS-CoV-2.Methods: This single-center retrospective study compared lung transplant recipients with SARS-CoV-2 between June 2020 and April 2021 with a matched control group. Within the SARS-CoV-2 cohort, univariable associations between clinical factors and outcomes were tested. Changes in pulmonary function tests were analyzed. Primary endpoints included acute cellular rejection and all-cause mortality within 12 months. Results: 53 lung transplant recipients were infected with SARS-CoV-2. The median age was 64 years. 29 (54.7%) were managed outpatient, and 24 (45.3%) required hospitalization, with 13 intensive care unit admissions. All-cause mortality was 24.5%. Within the SARS-CoV-2 cohort, older age was significantly associated with all-cause mortality (p-value 0.017) as was ICU admission (p=0.009) and an A1C >6.5 (p= 0.033). The mean change in FEV1 was -1.1% at 3 months with minimal change at 6 and 12 months (-2.6% and -1% respectively), all compared to baseline. Acute cellular rejection was identified in 13.7% of the SARS-CoV-2 cohort compared to 11.8% in the matched control group; it was not significantly associated with the infection status (p=0.706). However, all-cause mortality was significantly associated with infection status (p=0.019). Conclusion: Long-term outcomes of SARS-CoV-2 in lung transplant recipients are widely variable. Within the SARS-CoV-2 cohort, all-cause mortality was 24.5%, and older age was significantly associated with mortality. We did not observe significant declines in FEV1 in this group.
Keywords: COVID - 19, SARS CoV2 infection, Acute cellular rejection (ACR), lung transplant, Immune compromise, FEV 1, Mortality
Received: 26 Feb 2025; Accepted: 21 Apr 2025.
Copyright: © 2025 Hanna, Hallak, Leonard, Morrison, Peskoe, Whitson, Reynolds, Wolfe and Ali. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Sandrine Hanna, Duke University Medical Center, Duke University, Durham, United States
Hakim Azfar Ali, Duke University Medical Center, Duke University, Durham, United States
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