Predictors and outcomes of respiratory failure among lung transplant patients with COVID-19

Background: There is limited data on the predictors and outcomes of new or worsening respiratory failure among lung transplant (LT) patients with Coronavirus disease 2019 (COVID-19). Methods: We included all the LT patients diagnosed with COVID-19 during a 1-year period (March 2020 to February 2021; n = 54; median age: 60, 20–73 years; M:F 37:17). Development of new or worsening respiratory failure (ARF) was the primary outcome variable. Results: The overall incidence of ARF was 48.1% (n = 26). More than 20% of patients (n = 11) needed intubation and mechanical ventilation. Body mass index > 25 Kg/m² (adjusted OR: 5.7,.99–32.93; P =.05) and peak D-dimer levels >.95 mcg/ml (adjusted OR: 24.99, 1.77–353.8; P =.017) were independently associated with ARF while anticoagulation use prior to COVID-19 was protective (adjusted OR:.024,.001–.55; P =.02). Majority patients survived the acute illness (85.2%). Pre-infection chronic lung allograft dysfunction (CLAD) was an independent predictor of mortality (adjusted HR: 5.03, 1.14–22.25; P =.033). Conclusions: COVID-19 is associated with significant morbidity and mortality among LT patients. Patients on chronic anticoagulation seem to enjoy favorable outcomes, while higher BMI and peak D-dimer levels are associated with development of ARF. Pre-infection CLAD is associated with an increased risk of death from COVID-19.