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Kawana S, Sugimoto S, Matsubara K, Choshi H, Tanaka S, Ishihara M, Habu T, Hashimoto K, Suzawa K, Shien K, Miyoshi K, Okazaki M, Nakayama M, Toyooka S. Augmented humoral response to third and fourth dose of SARS-CoV-2 mRNA vaccines in lung transplant recipients. Respir Investig 2024; 62:804-810. [PMID: 39002293 DOI: 10.1016/j.resinv.2024.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 06/13/2024] [Accepted: 07/05/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND Since lung transplant recipients (LTRs) exhibit low immunogenicity after two doses of SARS-CoV-2 mRNA vaccines, optimal vaccine strategies for SARS-CoV-2 are required in LTRs. This study aimed to investigate the efficacy and safety of the third and fourth doses of the SARS-CoV-2 mRNA vaccines in LTRs. METHODS We conducted a single-center study of 73 LTRs and 23 healthy controls (HCs). Participants received two-to-four doses of SARS-CoV-2 mRNA vaccines. The LTRs were divided into three groups based on the number of vaccine dose. IgG titers against SARS-CoV-2 spike protein were measured, and adverse events were assessed. Factors associated with humoral response were analyzed using univariate and multivariate analyses. RESULTS The Dose 4 group (n = 27) had a higher humoral response rate (P = 0.018) and higher levels of anti-SARS-CoV-2 IgG antibody (P = 0.04) than the Dose 2 group (n = 14). The Dose 3 group (n = 32) had lower humoral response rates (P = 0.005) and levels of anti-SARS-CoV-2 IgG antibody (P = 0.0005) than the HCs (n = 23) even after the same dose. Systemic adverse events were milder in the LTRs than in the HCs (P < 0.05). Increased number of vaccine dose was identified as a predictor of positive humoral response (P = 0.021). CONCLUSION Booster doses of SARS-CoV-2 mRNA vaccines may enhance humoral response with mild adverse events in LTRs. Repeated vaccination might be warranted for LTRs to prevent SARS-CoV-2 infection.
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Affiliation(s)
- Shinichi Kawana
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Japan
| | - Seiichiro Sugimoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Japan.
| | - Kei Matsubara
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Japan
| | - Haruki Choshi
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Japan
| | - Shin Tanaka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Japan
| | - Megumi Ishihara
- Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Japan
| | - Tomohiro Habu
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Japan; Office of Innovative Medicine, Organization for Research Strategy and Development, Okayama University, Japan
| | - Kohei Hashimoto
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Japan
| | - Ken Suzawa
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Japan
| | - Kazuhiko Shien
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Japan
| | - Kentaroh Miyoshi
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Japan
| | - Mikio Okazaki
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Japan
| | - Masanori Nakayama
- Office of Innovative Medicine, Organization for Research Strategy and Development, Okayama University, Japan; Laboratory for Cell Polarity and Organogenesis, Max Planck Institute for Heart and Lung Research, Japan
| | - Shinichi Toyooka
- Department of General Thoracic Surgery and Breast and Endocrinological Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan; Department of General Thoracic Surgery and Organ Transplant Center, Okayama University Hospital, Japan
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Ennis SL, Levvey BJ, Shingles HV, Lee SJ, Snell GI, Gardiner BJ. COVID-19 infection is mild and has minimal impact on lung function in well vaccinated and widely treated lung transplant recipients. J Heart Lung Transplant 2024; 43:944-953. [PMID: 38408548 DOI: 10.1016/j.healun.2024.02.1453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 02/11/2024] [Accepted: 02/20/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND COVID-19 has become a common infection affecting lung transplant recipients (LTR), who are at high risk for poor outcomes. Outcomes early in the pandemic were poor, but since the rollout of vaccination and novel COVID-19 treatments, outcomes of LTR have not been well described. Our aim was to evaluate the effect of COVID-19 on the clinical course and lung function trajectory in an Australian cohort of LTR. METHODS Data were retrospectively collected from LTR with confirmed COVID-19 managed at Alfred Health, between August 2020 and December 2022. Baseline demographics, COVID-19 disease details (including severity) and spirometry pre- and postinfection have been analyzed. RESULTS A total of 279 LTR were included. The cohort was comorbid, but well vaccinated, with 275/279 (98.6%) having ≥2 COVID-19 vaccines at symptom onset. Severe disease occurred in only 17 cases (6%) and overall mortality was very low (4%). Prompt treatment with antivirals, particularly remdesevir (OR 0.18, 95% CI 0.04-0.81, p = 0.02) and vaccination (OR 0.24, CI 0.08-0.81, p = 0.01), was protective. There was not a clinically significant drop in lung function post-COVID-19 with the median absolute decline in forced expiratory volume (FEV1) being 40 ml (IQR 5-120 ml, p < 0.001), with a decline of >10% occurring in only 42 patients (17%). After multivariate adjustment, only rejection before COVID-19 was significantly associated with FEV1 decline afterward (OR 3.74, 1.12-11.86, p = 0.03). CONCLUSIONS In our highly COVID-19 vaccinated, promptly treated LTR, the majority of COVID-19 infections were mild and did not result in a clinically significant decline in lung function.
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Affiliation(s)
- Samantha L Ennis
- Department of Respiratory Medicine & Lung Transplantation, Alfred Health Melbourne, Victoria, Australia.
| | - Bronwyn J Levvey
- Department of Respiratory Medicine & Lung Transplantation, Alfred Health Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Helen V Shingles
- Department of Respiratory Medicine & Lung Transplantation, Alfred Health Melbourne, Victoria, Australia
| | - Sue J Lee
- Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Infectious Disease, Alfred Health, Melbourne, Victoria, Australia; Mahidol-Oxford Tropical Medicine Research Unit (MORU), Bangkok, Thailand and Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom
| | - Gregory I Snell
- Department of Respiratory Medicine & Lung Transplantation, Alfred Health Melbourne, Victoria, Australia; Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Bradley J Gardiner
- Central Clinical School, Monash University, Melbourne, Victoria, Australia; Department of Infectious Disease, Alfred Health, Melbourne, Victoria, Australia
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Sindu D, Razia D, Bay C, Padiyar J, Grief K, Buddhdev B, Arjuna A, Abdelrazek H, Mohamed H, McAnally K, Omar A, Walia R, Schaheen L, Tokman S. Evolving impact of the COVID-19 pandemic on lung transplant recipients: A single-center experience. J Heart Lung Transplant 2024; 43:442-452. [PMID: 37852512 DOI: 10.1016/j.healun.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 09/19/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Lung transplant recipients (LTRs) are at increased risk of morbidity and mortality from coronavirus disease 2019 (COVID-19); however, the disease course has changed as severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) variants have mutated. We compared COVID-19-related clinical outcomes in LTRs at different stages of the pandemic. We also identified risk factors for developing severe COVID-19 independent of the dominant SARS-CoV-2 variant. METHODS This single-center, retrospective cohort study of LTRs with COVID-19 used Cox regression analyses and bootstrapping to identify factors affecting COVID-19 severity. RESULTS Between March 2020 and August 2022, 195 LTRs were diagnosed with COVID-19, almost half (89 [45.6%]) during the Omicron period. A total of 113 (58.5%) LTRs were hospitalized and 47 (24.1%) died. Age >65 years increased the risk of hospitalization and death. Although infection with the Omicron variant was associated with a lower risk of hospitalization, the median length of hospital stay (10 days, [interquartile range, 5-19]) was similar between the variants. Intensive care unit (ICU) admission and death were more common with the Delta variant but comparable between the original, Alpha, and Omicron variants. Remdesivir and molnupiravir reduced the risk of hospitalization, and monoclonal antibody therapy reduced the risk of ICU admission, intubation, and death. Vaccination and pre-exposure prophylaxis (PrEP) with tixagevimab-cilgavimab did not significantly reduce COVID-19-related ICU admission, intubation, or mortality among LTRs. CONCLUSIONS LTRs with COVID-19 continue to have high hospitalization rates and prolonged hospital stays, despite the reduced virulence of the Omicron variant. More effective PrEP and therapeutic interventions for COVID-19 among vulnerable patient groups are needed.
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Affiliation(s)
- Devika Sindu
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Deepika Razia
- Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Curt Bay
- Department of Interdisciplinary Health Sciences, A. T. Still University, Phoenix, Arizona
| | - Josna Padiyar
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Katherine Grief
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Bhuvin Buddhdev
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Ashwini Arjuna
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Hesham Abdelrazek
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Hesham Mohamed
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Kendra McAnally
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Ashraf Omar
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Rajat Walia
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Lara Schaheen
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Surgery, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona
| | - Sofya Tokman
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Department of Medicine, Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona.
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Sindu D, Razia D, Grief K, Cherrier L, Omar A, Walia R, McAnally K, Buddhdev B, Tokman S. Prior SARS-CoV-2 infection may not alter the clinical course of COVID-19 in lung transplant recipients: A single-center experience. Clin Transplant 2023; 37:e15071. [PMID: 37405931 DOI: 10.1111/ctr.15071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/01/2023] [Accepted: 06/26/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND In the general population, prior infection with SARS-CoV-2 reduces the risk of severe COVID-19; however, studies in lung transplant recipients (LTRs) are lacking. We sought to describe the clinical course of COVID-19 recurrence and compare outcomes between the first and second episodes of COVID-19 in LTRs. METHODS We conducted a retrospective, single-center cohort study of LTRs with COVID-19 between January 1, 2022, and September 30, 2022, during the Omicron wave. We compared the clinical course of a second episode of COVID-19 to that of the patients' own first episode and to that of LTRs who developed a first episode during the study period. RESULTS During the study period, we identified 24 LTRs with COVID-19 recurrence and another 75 LTRs with a first episode of COVID-19. LTRs who survived the initial episode of COVID-19 had a similar disease course with recurrence, with a trend toward reduced hospitalization (10 (41.6%) vs. 4 (16.7%), p = .114). Furthermore, compared to LTRs with a primary infection during the Omicron wave, those with a reinfection had a non-statistically significant trend toward reduced hospitalizations (aOR .391, 95% CI [.115-1.321], p = .131), shorter lengths-of-stay (median, 4 vs. 9 days, p = .181), and reduced intensive care unit admissions, intubations, and COVID-19-related mortality. CONCLUSIONS LTRs who survive the first episode of COVID-19 are likely to have a similar clinical course with recurrent episodes. Although recurrent COVID-19 may be milder, larger, well-powered studies are needed to confirm this observation. Ongoing precautions are warranted.
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Affiliation(s)
- Devika Sindu
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Deepika Razia
- Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona, USA
| | - Katherine Grief
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Lauren Cherrier
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Ashraf Omar
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
- Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona, USA
| | - Rajat Walia
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
- Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona, USA
| | - Kendra McAnally
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
- Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona, USA
| | - Bhuvin Buddhdev
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
- Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona, USA
| | - Sofya Tokman
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
- Creighton University School of Medicine - Phoenix Regional Campus, Phoenix, Arizona, USA
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Narasimhan M, Muthukumar A, Sataranatarajan K, Mahimainathan L, Mahan L, Timofte I, Bollineni S, Joerns J, Zhang S, Gorman A, Banga A, Mohanka M, Torres F, Lawrence A, Thalachallour M, Kaza V. Crossroads between Autoimmunity and COVID-19 in Lung Transplant Recipients. Viruses 2023; 15:2045. [PMID: 37896822 PMCID: PMC10612071 DOI: 10.3390/v15102045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 09/25/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
The presence of a certain group of auto-antibodies (AAbs) is known to correlate with the severity of COVID-19. It is, however, unknown if such AAbs are prevalent and impact COVID-19-related outcomes in lung transplant recipients (LTRs) who are immunosuppressed. We performed a retrospective study of LTRs with COVID-19 and analyzed samples before and after COVID-19 for IgG AAbs. AAbs analysis was carried out using autoimmune and coronavirus microarray and the resulting cross-sectional differences in Ab-scores and clinical variables were analyzed using Fischer's Exact test for categorical variables and a paired t-test for continuous variables. Linear regression was used to analyze the differences in Ab-scores and COVID-19 severity. LTRs with non-severe [NS gp (n = 10)], and severe [S gp (n = 8)] COVID-19 disease were included. Ferritin and acute respiratory failure were higher in the S group (p = 0.03; p < 0.0001). Among the AAbs analyzed, interferon-related AAbs (IFN-alpha2, IFN-beta, IFN lamba, IFN-epsilon), eight interleukin-related AAbs, and several tissue-related AAbs were also found to be changed significantly from pre- to post-COVID-19 (p < 0.05). IFN-lambda (p = 0.03) and IL-22 (p = 0.002) were significantly associated with COVID-19 severity and remained significant in linear regression analysis while controlling for other variables. AAbs are common in LTRs, and certain groups of antibodies are particularly enhanced in LTRs with severe COVID-19. Preliminary observations of this study need to be confirmed by a larger sample size.
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Affiliation(s)
- Madhusudhanan Narasimhan
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (M.N.); (A.M.); (K.S.); (L.M.)
| | - Alagarraju Muthukumar
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (M.N.); (A.M.); (K.S.); (L.M.)
| | - Kavithalakshmi Sataranatarajan
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (M.N.); (A.M.); (K.S.); (L.M.)
| | - Lenin Mahimainathan
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (M.N.); (A.M.); (K.S.); (L.M.)
| | - Luke Mahan
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (L.M.); (I.T.); (S.B.); (J.J.); (A.B.); (M.M.); (F.T.); (A.L.)
| | - Irina Timofte
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (L.M.); (I.T.); (S.B.); (J.J.); (A.B.); (M.M.); (F.T.); (A.L.)
| | - Srinivas Bollineni
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (L.M.); (I.T.); (S.B.); (J.J.); (A.B.); (M.M.); (F.T.); (A.L.)
| | - John Joerns
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (L.M.); (I.T.); (S.B.); (J.J.); (A.B.); (M.M.); (F.T.); (A.L.)
| | - Song Zhang
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.Z.); (A.G.)
| | - April Gorman
- Peter O’Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (S.Z.); (A.G.)
| | - Amit Banga
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (L.M.); (I.T.); (S.B.); (J.J.); (A.B.); (M.M.); (F.T.); (A.L.)
| | - Manish Mohanka
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (L.M.); (I.T.); (S.B.); (J.J.); (A.B.); (M.M.); (F.T.); (A.L.)
| | - Fernando Torres
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (L.M.); (I.T.); (S.B.); (J.J.); (A.B.); (M.M.); (F.T.); (A.L.)
| | - Adrian Lawrence
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (L.M.); (I.T.); (S.B.); (J.J.); (A.B.); (M.M.); (F.T.); (A.L.)
| | | | - Vaidehi Kaza
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; (L.M.); (I.T.); (S.B.); (J.J.); (A.B.); (M.M.); (F.T.); (A.L.)
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6
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Current and Emerging Therapies for COVID-19 in Lung Transplantation. CURRENT PULMONOLOGY REPORTS 2023; 12:23-35. [PMID: 36820015 PMCID: PMC9932416 DOI: 10.1007/s13665-023-00302-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/18/2023]
Abstract
Purpose of Review The landscape of the coronavirus disease 2019 (COVID-19) pandemic has rapidly changed over the past 3 years. Paralleling this evolution, the scientific and medical communities have reported many novel findings relating to the infection's epidemiology, transmission, diagnosis, and treatment. We review pertinent studies of COVID-19 therapeutics with an emphasis on their application to lung transplant recipients. Recent Findings Agents that have been well-studied for treating COVID-19 include antivirals (remdesivir, nirmatrelvir/ritonavir, molnupiravir), monoclonal antibodies, and immunomodulators (for example, corticosteroids and tocilizumab). Summary Remdesivir remains an essential therapy for managing mild-moderate COVID-19. Though highly efficacious for mild-moderate COVID-19 for outpatient therapy, ritonavir-boosted nirmatrelvir has limited use in lung transplant recipients due to significant drug-drug interactions. Monoclonal antibodies, though useful, are the most affected by the emergence of new viral variants.
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7
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Nada KM, Polychronopoulou E, Sharma G, Duarte AG. Corticosteroids and Outcomes in Solid Organ Transplant Recipients Infected With Severe Acute Respiratory Syndrome Coronavirus 2. Mayo Clin Proc Innov Qual Outcomes 2023; 7:99-108. [PMID: 36778134 PMCID: PMC9894766 DOI: 10.1016/j.mayocpiqo.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/20/2023] [Accepted: 01/23/2023] [Indexed: 02/05/2023] Open
Abstract
Objective To examine outcomes in organ transplant and nontransplant patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection during the initial 22 months of the pandemic. Patients and Methods We used Optum electronic health records to compare outcomes between an adult transplant group and a propensity-matched nontransplant group that tested positive for SARS-CoV-2 from February 1, 2020, to December 15, 2021. Baseline characteristics, hospitalization, intensive care unit admission, mechanical ventilation, renal replacement therapy, inpatient, and 90-day mortality were compared between the transplant and nontransplant groups and among specific transplant recipients. Cox proportional analysis was used to examine hospitalization and mortality by organ transplant, medical therapy, sex, and the period of the pandemic. Results We identified 876,959 patients with SARS-CoV-2 infection, of whom 3548 were organ transplant recipients. The transplant recipients had a higher risk of hospitalization (30.6% vs 25%, respectively; P<.001), greater use of mechanical ventilation (7.8% vs 5.6%, respectively; P<.001), and increased inpatient mortality (6.7% vs 4.7%, respectively; P<.001) compared with the nontransplant patients. The initiation of mechanical ventilation was significantly more frequent in the transplant group. After adjustment for baseline characteristics and comorbidities, the transplant group had a higher risk of hospitalization (odds ratio, 1.38; 95% confidence interval, 1.19-1.59), without a difference in mortality. In the transplant group, lung transplant recipients had the highest inpatient mortality (11.6%). Conclusion Among patients with SARS-CoV-2 infection, the transplant recipients were at a higher risk of hospitalization and inpatient mortality; however, mortality was mainly driven by advanced age and comorbidities rather than by transplant status or immunosuppressive medications. Lung transplant recipients had the greatest inpatient and 90-day mortality.
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Affiliation(s)
- Khaled M. Nada
- Department of Internal Medicine, Division of Pulmonary and Critical care, University of Texas Medical Branch, Galveston, TX
| | | | - Gulshan Sharma
- Department of Internal Medicine, Division of Pulmonary and Critical care, University of Texas Medical Branch, Galveston, TX
| | - Alexander G. Duarte
- Department of Internal Medicine, Division of Pulmonary and Critical care, University of Texas Medical Branch, Galveston, TX,Correspondence: Address to Alexander Duarte, MD, The University of Texas Medical Branch at Galveston, 301 University Boulevard, 5.140 John Sealy Annex, Galveston, TX 77555-0561.
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Courtwright AM, Devarajan J, Fritz AV, Martin AK, Wilkey B, Subramani S, Cassara CM, Tawil JN, Miltiades AN, Boisen ML, Bottiger BA, Pollak A, Gelzinis TA. Cardiothoracic Transplant Anesthesia: Selected Highlights: Part I-Lung Transplantation. J Cardiothorac Vasc Anesth 2023; 37:884-903. [PMID: 36868904 DOI: 10.1053/j.jvca.2023.01.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 01/30/2023]
Affiliation(s)
| | | | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Mayo Clinic, Jacksonville, FL
| | | | - Barbara Wilkey
- Department of Anesthesiology, University of Colorado, Aurora, CO
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals & Clinics, Iowa City, IA
| | - Christopher M Cassara
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Justin N Tawil
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Andrea N Miltiades
- Department of Anesthesiology, Columbia University Medical Center, New York, NY
| | - Michael L Boisen
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Brandi A Bottiger
- Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh, Pittsburgh, PA
| | - Angela Pollak
- Department of Anesthesiology, Duke University, Durham, NC
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Hochhegger B, Pelaez A, Machuca T, Mohammed TL, Patel P, Zanon M, Torres F, Altmayer S, Nascimento DZ. CT imaging findings in lung transplant recipients with COVID-19. Eur Radiol 2023; 33:2089-2095. [PMID: 36152040 PMCID: PMC9510464 DOI: 10.1007/s00330-022-09148-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/28/2022] [Accepted: 09/06/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Our goal was to compare the chest computed tomography (CT) imaging findings of COVID-19 in lung transplant recipients (LTR) and a group of non-transplanted controls (NTC). METHODS This retrospective study included 51 consecutive LTR hospitalized with COVID-19 from two centers. A total of 75 NTC were included for comparison. Images were classified regarding the standardized RSNA category, main pattern of lung attenuation, and longitudinal and axial distribution. Quantitative CT (QCT) analysis was performed to evaluate percentage of high attenuation areas (%HAA, threshold -250 to -700 HU). CT scoring was used to measure severity of parenchymal abnormalities. RESULTS The imaging findings of COVID-19 in LTR were significantly different from controls regarding the RSNA classification and pattern of lung attenuation. LTR had a significantly higher proportion of patients with an indeterminate pattern on CT (0.31 vs. 0.11, p = 0.014). The most frequent pattern of attenuation in LTR was predominantly consolidation (0.39 vs. 0.22, p = 0.144) followed by a mixed pattern of ground-glass opacities (GGO) and consolidation (0.37 vs. 0.20, adjusted p = 0.102). On the other hand, the most common pattern in NTC was GGO predominant (0.58 vs. 0.24 of LTR, p = 0.001). LTR had significantly more severe parenchymal disease measured by CT score and %HAA by QCT (0.372 ± 0.08 vs. 0.148 ± 0.06, p < 0.001). CONCLUSION The most frequent finding of COVID-19 in LTR is a predominant pattern of consolidation. Compared to NTC, LTR more frequently demonstrated an indeterminate pattern according to the RSNA classification and more extensive lung abnormalities on QCT and semi-quantitative scoring. KEY POINTS • The most common CT finding of COVID-19 in LTR is a predominant pattern of consolidation followed by a mixed pattern of GGO and consolidation, while controls more often have a predominant pattern of GGO. • LTR more often presents with an indeterminate pattern of COVID-19 by RSNA classification than controls; therefore, molecular testing for COVID-19 is essential for LTR presenting with lower airway infection independently of imaging findings. • LTR had more extensive disease by semi-quantitative CT score and increased percentage areas of high attenuation on QCT.
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Affiliation(s)
- Bruno Hochhegger
- Department of Radiology, University of Florida, Gainesville, FL, USA.
| | - Andres Pelaez
- Department of Medicine, University of Florida, Gainesville, FL USA
| | - Tiago Machuca
- Department of Surgery, University of Florida, Gainesville, FL USA
| | | | - Pratik Patel
- Department of Radiology, University of Florida, Gainesville, FL USA
| | - Matheus Zanon
- Department of Radiology, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Felipe Torres
- Department of Radiology, University of Toronto, Toronto, Canada
| | - Stephan Altmayer
- Department of Radiology, Pontificia Universidade Catolica do Rio Grande do Sul, Porto Alegre, Brazil
| | - Douglas Zaione Nascimento
- Department of Lung Transplantation, Santa Casa de Misericordia de Porto Alegre, Porto Alegre, Brazil
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10
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Impact of Omicron on Lung Transplant Recipients: A Third COVID-19 Surge with Different Outcomes. Ann Am Thorac Soc 2023; 20:148-151. [PMID: 36049092 PMCID: PMC9819269 DOI: 10.1513/annalsats.202205-452rl] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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11
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Trindade AJ, Chapin KC, Gannon WD, Hoy H, Demarest CT, Lambright ES, McPherson KA, Norfolk SG, Robbins IM, Bacchetta M, Erasmus DB, Shaver CM. Clinical course of SARS-CoV-2 infection and recovery in lung transplant recipients. Transpl Infect Dis 2022; 24:e13967. [PMID: 36271645 PMCID: PMC9780187 DOI: 10.1111/tid.13967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/03/2022] [Accepted: 08/26/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Reports on outcomes following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in lung transplant recipients remain limited. METHODS We performed a single-center, observational study of outcomes in lung transplant recipients diagnosed with SARS-CoV-2 between 5/1/2020 and 3/15/2022 that were followed for a median of 123 days. We analyzed changes in spirometry, acute lung allograft dysfunction (ALAD) incidence, hospitalization, mechanical ventilation needs, secondary infection, and survival. RESULTS In our cohort of 336 patients, 103 developed coronavirus disease (COVID) (27 pre-Delta, 20 Delta, and 56 Omicron-era). Twenty-five patients (24%) required hospitalization and 10 patients ultimately died (10%). Among 85 survivors who completed ambulatory spirometry, COVID-19 did not alter change in forced expiratory volume in 1 s (FEV1 ) or forced vital capacity (FVC) over time compared to the preceding 6 months. The pre-COVID FEV1 change was -0.05 ml/day (IQR -0.50 to 0.60) compared to -0.20 ml/day (IQR -1.40 to 0.70) post-COVID (p = .16). The pre-COVID change in FVC was 0.20 ml/day (IQR -0.60 to 0.70) compared to 0.05 ml/day (IQR -1.00 to 1.10) post-COVID (p = .76). Although the cohort overall had stable lung function, 33 patients (39%) developed ALAD or accelerated chronic lung allograft dysfunction (FEV1 decline >10% from pre-COVID baseline). Nine patients (35%) with ALAD recovered lung function. Within 3 months of acute COVID infection, 18 patients (17%) developed secondary infections, the majority being bacterial pneumonia. Finally, vaccination with at least two doses of mRNA vaccine was not associated with improved outcomes. CONCLUSIONS This study describes the natural history of SARS-CoV-2 infection in a large cohort of lung transplant recipients. Although one third of patients develop ALAD requiring augmented immunosuppression, infection with SARS-CoV-2 is not associated with worsening lung function.
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Affiliation(s)
- Anil J. Trindade
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Kaitlyn C. Chapin
- Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN
| | - Whitney D. Gannon
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Haley Hoy
- Vanderbilt Transplant Center, Vanderbilt University Medical Center, Nashville, TN
| | - Caitlin T. Demarest
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Eric S. Lambright
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Katie A. McPherson
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Stephanie G. Norfolk
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ivan M. Robbins
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Matthew Bacchetta
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Biomedical Engineering, Vanderbilt University Medical Center, Nashville, TN
| | - David B. Erasmus
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ciara M. Shaver
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
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12
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Gallais F, Renaud-Picard B, Solis M, Laugel E, Soulier E, Caillard S, Kessler R, Fafi-Kremer S. Torque teno virus DNA load as a predictive marker of antibody response to a three-dose regimen of COVID-19 mRNA-based vaccine in lung transplant recipients. J Heart Lung Transplant 2022; 41:1429-1439. [PMID: 35953352 PMCID: PMC9287579 DOI: 10.1016/j.healun.2022.07.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 05/31/2022] [Accepted: 07/08/2022] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Previous studies have reported that lung transplant recipients (LTR) develop a poor response to two doses of COVID-19 vaccine, but data regarding the third dose are lacking. We investigated the antibody response after three doses of mRNA vaccine in LTR and its predictive factors. METHODS A total of 136 LTR, including 10 LTR previously infected and 126 COVID-19-naive LTR, were followed during and after three doses of mRNA vaccine. We retrospectively measured anti-receptor-binding domain (RBD) IgG response and neutralizing antibodies. In a posthoc analysis, we used a multivariate logistic regression model to assess the association between vaccine response and patient characteristics, including viral DNA load (VL) of the ubiquitous Torque teno virus (TTV) (optimal cut-off set by ROC curve analysis), which reflects the overall immunosuppression. RESULTS After 3 doses, 47/126 (37.3%) COVID-19-naive LTR had positive anti-RBD IgG (responders) and 14/126 (11.1%) had antibody titers above 264 Binding Antibody Units/mL. None neutralized the omicron variant versus 7 of the 10 previously infected LTR. Nonresponse was associated with TTV VL ≥6.2 log10 copies/mL before vaccination (Odds Ratio (OR) = 17.87, 95% confidence interval (CI95) = 3.02-105.72), mycophenolate treatment (OR = 4.73, CI95 = 1.46-15.34) and BNT162b2 (n = 34; vs mRNA-1273, n = 101) vaccine (OR = 6.72, CI95 = 1.75-25.92). In second dose non-responders, TTV VL ≥6.2 or <3.2 log10 copies/mL before the third dose was associated with low (0/19) and high (9/10) rates of seroconversion. CONCLUSION COVID-19-naive LTR respond poorly to three doses of mRNA vaccine, especially those with high TTV VL. Future studies could further evaluate this biomarker as a guide for vaccine strategies.
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Affiliation(s)
- Floriane Gallais
- Virology Laboratory, Strasbourg University Hospital, Strasbourg, France,Strasbourg University, INSERM, IRM UMR-S 1109, Strasbourg, France
| | - Benjamin Renaud-Picard
- Department of Pneumology, Strasbourg Lung Transplant Program, Strasbourg University Hospital, Strasbourg, France
| | - Morgane Solis
- Virology Laboratory, Strasbourg University Hospital, Strasbourg, France,Strasbourg University, INSERM, IRM UMR-S 1109, Strasbourg, France
| | - Elodie Laugel
- Virology Laboratory, Strasbourg University Hospital, Strasbourg, France,Strasbourg University, INSERM, IRM UMR-S 1109, Strasbourg, France
| | - Eric Soulier
- Strasbourg University, INSERM, IRM UMR-S 1109, Strasbourg, France
| | - Sophie Caillard
- Strasbourg University, INSERM, IRM UMR-S 1109, Strasbourg, France,Department of Nephrology and Transplantation, Strasbourg University Hospital, Strasbourg, France
| | - Romain Kessler
- Department of Pneumology, Strasbourg Lung Transplant Program, Strasbourg University Hospital, Strasbourg, France
| | - Samira Fafi-Kremer
- Virology Laboratory, Strasbourg University Hospital, Strasbourg, France,Strasbourg University, INSERM, IRM UMR-S 1109, Strasbourg, France,Reprint requests: Samira Fafi-Kremer, PharmD, PhD. Virology Laboratory and INSERM UMR_S 1109, LabEx TRANSPLANTEX, Strasbourg University Hospital, 3 rue Koeberlé, 67000 Strasbourg, France. Telephone: (+33) 3-69-55-14-38. Fax: (+33) 3-68-85-37-50
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13
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Bárczi E, Varga V, Nagy A, Eszes N, Jáky‐Kováts Z, Müller V, Bohács A. Serological findings following the second and third SARS-CoV-2 vaccines in lung transplant recipients. Immun Inflamm Dis 2022; 10:e646. [PMID: 35894705 PMCID: PMC9311263 DOI: 10.1002/iid3.646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/11/2022] [Accepted: 05/13/2022] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Lung transplant recipients (LuTX) represent a vulnerable population for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Even though many vaccines are already developed, more clinical data need to support effective immunological response in immunocompromised patients. METHODS Stable LuTX recipients with no medical history of coronavirus disease (COVID-19) were enrolled. Currently available messenger RNA (mRNA) (BNT162b2-mRNA, mRNA-1273) and non-mRNA (ChAdOx1, BBIBP-CorV) vaccines were given according to availability, boosters were all mRNA-based. SARS-CoV-2 Spike1 immunoglobulin G (IgG) antibody titer was evaluated before and 2 weeks after second and third dose. Difference between mRNA versus non-mRNA vaccines was assessed. RESULTS Forty-one patients (49% men, age 48.4 ± 13.8 years) received two doses of SARS-CoV-2 vaccines: 23 of mRNA, 18 of non-mRNA, and 24/41 (58%) received a third dose. Median 92 months passed since transplantation, and serum level of tacrolimus was median 5.5 ng/ml. Positive serology was found in 37% of all patients after the second dose, 86% had mRNA vaccine. After the third dose, 29% became positive who had no antibody before. Significantly higher level of antibody was found after the second mRNA than non-mRNA vaccines (2.2 vs. 1568.8 U/ml, respectively, p = .002). 6/23 (26%) patients received two doses of mRNA vaccine developed COVID-19 after the second injection in an average of 178 days, half of them recovered, half of them died in intensive care unit (ICU). 3/6 (50%) patients with two doses mRNA and recovered from COVID-19 had significantly higher level of antibody (average 20847.3 U/ml) than without infection. After the booster vaccine, 1/24 (4%) developed infection. CONCLUSION Immunosuppression therapy may induce a weaker SARS-CoV-2 response in LuTX recipients; therefore, third dose is a priority in transplanted patients. The highest antibody level was measured recovering from COVID after two doses. Our data confirm that booster mRNA vaccine could increase antibody levels, even if immunization was started with non-mRNA vaccine.
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Affiliation(s)
- Enikő Bárczi
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
| | - Viktória Varga
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
| | - Alexandra Nagy
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
| | - Noémi Eszes
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
| | | | - Veronika Müller
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
| | - Anikó Bohács
- Department of Pulmonology, Faculty of MedicineSemmelweis UniversityBudapestHungary
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14
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Bollineni S, Mahan LD, Lawrence A, Joerns J, Timofte I, Torres F, Kaza V, La Hoz RM, SoRelle JA, Kershaw CD, Terada LS, Zhang S, Mohanka MR, Banga A. COVID-19 vaccination is associated with favorable outcomes among lung transplant patients with breakthrough infections. Transplant Proc 2022; 54:1517-1523. [PMID: 35909014 PMCID: PMC9197779 DOI: 10.1016/j.transproceed.2022.05.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 05/26/2022] [Accepted: 05/31/2022] [Indexed: 11/19/2022]
Affiliation(s)
- Srinivas Bollineni
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Luke D Mahan
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Adrian Lawrence
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - John Joerns
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Irina Timofte
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Fernando Torres
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Vaidehi Kaza
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Ricardo M La Hoz
- Division of Infectious Diseases and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Jeffrey A SoRelle
- Department of Genomics and Molecular Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Corey D Kershaw
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Lance S Terada
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Song Zhang
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Manish R Mohanka
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amit Banga
- Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.
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15
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Roosma E, van Gemert JP, de Zwart AES, van Leer-Buter CC, Hellemons ME, Berg EM, Luijk B, Hoek RAS, van Kessel DA, Akkerman OW, Kerstjens HAM, Verschuuren EAM, Gan CT. The effect of COVID-19 on transplant function and development of CLAD in lung transplant patients: a multicenter experience. J Heart Lung Transplant 2022; 41:1237-1247. [PMID: 35843852 PMCID: PMC9212897 DOI: 10.1016/j.healun.2022.06.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 05/19/2022] [Accepted: 06/14/2022] [Indexed: 12/23/2022] Open
Abstract
Background Concerns have been raised on the impact of coronavirus disease (COVID-19) on lung transplant (LTx) patients. The aim of this study was to evaluate the transplant function pre- and post-COVID-19 in LTx patients. Methods Data were retrospectively collected from LTx patients with confirmed COVID-19 from all 3 Dutch transplant centers, between February 2020 and September 2021. Spirometry results were collected pre-COVID-19, 3- and 6-months post infection. Results Seventy-four LTx patients were included. Forty-two (57%) patients were admitted, 19 (26%) to the intensive care unit (ICU). The in-hospital mortality was 20%. Twelve out of 19 ICU patients died (63%), a further 3 died on general wards. Patients with available spirometry (78% at 3 months, 65% at 6 months) showed a significant decline in mean forced expiratory volume in 1 second (FEV1) (ΔFEV1 138 ± 39 ml, p = 0.001), and forced vital capacity (FVC) (ΔFVC 233 ±74 ml, p = 0.000) 3 months post infection. Lung function improved slightly from 3 to 6 months after COVID-19 (ΔFEV1 24 ± 38 ml; ΔFVC 100 ± 46 ml), but remained significantly lower than pre-COVID-19 values (ΔFEV1 86 ml ± 36 ml, p = 0.021; ΔFVC 117 ± 35 ml, p = 0.012). FEV1/FVC was > 0.70. Conclusions In LTx patients COVID-19 results in high mortality in hospitalized patients. Lung function declined 3 months after infection and gradually improved at 6 months, but remained significantly lower compared to pre-COVID-19 values. The more significant decline in FVC than in FEV1 and FEV1/FVC > 70%, suggested a more restrictive pattern.
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Affiliation(s)
- Elizabeth Roosma
- Department of Respiratory Diseases, Martini Ziekenhuis, Groningen, The Netherlands
| | - Johanna P van Gemert
- Department of Respiratory Diseases, Tuberculosis and Lung Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Auke E S de Zwart
- Department of Respiratory Diseases, Tuberculosis and Lung Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Coretta C van Leer-Buter
- Department of Virology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Merel E Hellemons
- Department of Respiratory Diseases, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, The Netherlands
| | - Elize M Berg
- Department of Respiratory Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Bart Luijk
- Department of Respiratory Diseases, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rogier A S Hoek
- Department of Respiratory Diseases, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, The Netherlands
| | - Diana A van Kessel
- Department of Respiratory Diseases, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Onno W Akkerman
- Department of Respiratory Diseases, Tuberculosis and Lung Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Huib A M Kerstjens
- Department of Respiratory Diseases, Tuberculosis and Lung Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Erik A M Verschuuren
- Department of Respiratory Diseases, Tuberculosis and Lung Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - C Tji Gan
- Department of Respiratory Diseases, Tuberculosis and Lung Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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16
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Bollineni S, Mahan LD, Duncan P, Mohanka MR, Lawrence A, Joerns J, Timofte I, Torres F, La Hoz RM, Kershaw CD, Terada LS, Kaza V, Banga A. Characteristics and outcomes among vaccinated lung transplant patients with breakthrough COVID-19. Transpl Infect Dis 2022; 24:e13784. [PMID: 34968012 DOI: 10.1111/tid.13784] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 11/26/2021] [Accepted: 12/14/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Despite multiple studies evaluating the immunological responsiveness to vaccines, the clinical effectiveness of the two-dose mRNA vaccine schedule among lung transplant (LT) patients has not been evaluated. METHODS We included LT patients who tested positive for SARS-CoV-2 on a nasopharyngeal swab between March 1, 2020, and August 25, 2021 (n = 70). The study group was divided based on their vaccination status. RESULTS During the study period, 14 fully vaccinated LT patients with one of the mRNA vaccines tested positive for COVID-19 (median age 54, range 30-62 years, M:F 9:5). The vaccinated cohort was younger with bilateral LT, have suppurative conditions as the transplant indication, and present with milder symptoms. However, pulmonary parenchymal involvement was seen among all 12 patients where computed tomography (CT) of chest was available. The laboratory profile indicated a more subdued inflammatory response among the vaccinated group. A lower proportion of vaccinated patients developed respiratory failure, needed ICU admission or ventilator support, although none of the differences achieved statistical significance. None of the vaccinated patients succumbed to COVID-19 during the study period, while the 4-week mortality among unvaccinated patients was nearly 15% (8/56). CONCLUSIONS In this cohort of vaccinated LT patients who developed breakthrough COVID-19, the clinical course, risk of complications, and outcomes trended better than unvaccinated patients. However, universal involvement of the allograft demonstrates the continued vulnerability of these patients to significant sequelae from COVID-19. Future studies may evaluate the incremental protection of vaccination after the completion of the third dose of mRNA vaccines among LT patients.
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Affiliation(s)
- Srinivas Bollineni
- Department of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Luke D Mahan
- Department of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Patrick Duncan
- Department of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Manish R Mohanka
- Department of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Adrian Lawrence
- Department of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - John Joerns
- Department of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Irina Timofte
- Department of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Fernando Torres
- Department of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ricardo M La Hoz
- Infectious Disease and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Corey D Kershaw
- Department of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Lance S Terada
- Department of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Vaidehi Kaza
- Department of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amit Banga
- Department of Internal Medicine, Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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17
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One Year Into the Pandemic: Evolving COVID-19 Outcomes in Lung Transplant Recipients, a Single-center Experience. Transplant Direct 2022; 8:e1296. [PMID: 35368985 PMCID: PMC8966964 DOI: 10.1097/txd.0000000000001296] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 12/24/2021] [Indexed: 12/20/2022] Open
Abstract
In the early months of the coronavirus disease 2019 (COVID-19) pandemic, our center reported a mortality rate of 34% in a cohort of 32 lung transplant recipients with COVID-19 between March and May 2020. Since then, there has been evolving knowledge in prevention and treatments of COVID-19. To evaluate the impact of these changes, we describe the clinical presentation, management, and outcomes of a more recent cohort of lung transplant recipients during the second surge and provide a comparison with our first cohort.
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18
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Nikolina BJ, Sanjin R, Ivana T, Mirna A, Batric B, Ivana J, Vesna FC, Lea K, Dubravka M, Sofija V, Enisa M, Bojan J, Zeljko K. Hospitalization and death after recovery from acute COVID-19 among renal transplant recipients. Clin Transplant 2021; 36:e14572. [PMID: 34967958 DOI: 10.1111/ctr.14572] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 12/01/2022]
Abstract
Data on post-COVID-19 infection in renal transplant recipients (RTR) are scarce. We investigated the rate of hospitalization, reasons for hospital admission, and mortality rate among RTR who survived acute COVID-19. A multi-center retrospective observational cohort study measured hospital admission and death to 180 days after acute SARS-CoV-2 infection in 308 adult patients. The median age was 57 years; 64.9% were male. All patients had at least one comorbidity, and 26.3% had diabetes. Data on the post-COVID-19 course was available for 267 patients, and 49 of them (15,9%) required hospitalization after recovery from the acute infection. The most common indications included pneumonia (24.5%) and renal allograft dysfunction (22,4%); 7 (14,3%) had sepsis and 52 had thrombotic events. A median duration of the hospital stay was 12 days. Six patients (2.2%) died due to multiorgan failure3, respiratory insufficiency2 and urosepsis1. The strongest predictor for hospitalization after acute COVID-19 was hospitalization for the initial acute SARS-CoV-2 infection, while better allograft function decreased the probability of hospitalization. In conclusion, delayed consequences of acute COVID-19 are highly prevalent, and the health care systems should be prepared to respond to the needs of RTR suffering from post-COVID-19 complications. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Basic-Jukic Nikolina
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, School of medicine, University of Zagreb
| | - Racki Sanjin
- Department of Nephrology, Dialysis and Transplantation, University hospital Centre Rijeka
| | - Tolj Ivana
- Department of Nephrology, Dialysis and Transplantation, University hospital Centre Osijek
| | - Aleckovic Mirna
- Department of Nephrology, Dialysis and Transplantation, University hospital Centre Tuzla, Bosnia and Herzegovina
| | | | - Juric Ivana
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, School of medicine, University of Zagreb
| | - Furic-Cunko Vesna
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, School of medicine, University of Zagreb
| | - Katalinic Lea
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, School of medicine, University of Zagreb
| | - Mihaljevic Dubravka
- Department of Nephrology, Dialysis and Transplantation, University hospital Centre Osijek
| | - Vujic Sofija
- Department of Nephrology, Dialysis and Transplantation, University hospital Centre Rijeka
| | - Mesic Enisa
- Department of Nephrology, Dialysis and Transplantation, University hospital Centre Tuzla, Bosnia and Herzegovina
| | - Jelakovic Bojan
- Department of Nephrology, Arterial Hypertension, Dialysis and Transplantation, University Hospital Centre Zagreb, School of medicine, University of Zagreb
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Mahan LD, Lill I, Halverson Q, Mohanka MR, Lawrence A, Joerns J, Bollineni S, Kaza V, La Hoz RM, Zhang S, Kershaw CD, Terada LS, Torres F, Banga A. Post-infection pulmonary sequelae after COVID-19 among patients with lung transplantation. Transpl Infect Dis 2021; 23:e13739. [PMID: 34605596 PMCID: PMC8646912 DOI: 10.1111/tid.13739] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/12/2021] [Accepted: 09/15/2021] [Indexed: 12/22/2022]
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 3 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 forced vital capacity (FVC) or forced expiratory volume in 1 s (FEV1 ) on two spirometries, at least 3 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 × 103 /dl and ferritin > 150 ng/ml at the time of hospital discharge was independently associated with significant lung function loss. CONCLUSIONS A significant proportion of COVID-19 survivors suffer persistent allograft injury. Low absolute lymphocyte counts (ALC) and elevated ferritin levels 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 Lung transplant patients who survive COVID-19 suffer significant morbidity with persistent pulmonary opacities, loss of lung functions, and functional deficits. Residual elevation of the inflammatory markers is predictive.
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Affiliation(s)
- Luke D Mahan
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Isaac Lill
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Quinn Halverson
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Manish R Mohanka
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Adrian Lawrence
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - John Joerns
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Srinivas Bollineni
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Vaidehi Kaza
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Ricardo M La Hoz
- Infectious Disease and Geographic Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Song Zhang
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Corey D Kershaw
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Lance S Terada
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Fernando Torres
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Amit Banga
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
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