key: cord-1037855-bch3dacu authors: Ochman, Marek; Latos, Magdalena; Galle, Dagmara; Niepokój, Kornelia; Stącel, Tomasz; Urlik, Maciej; Zawadzki, Fryderyk; Przybyłowski, Piotr title: Coronavirus disease of 2019 (COVID-19) among lung transplant recipients – a single center study date: 2022-04-11 journal: Transplant Proc DOI: 10.1016/j.transproceed.2022.03.011 sha: 9d5e8e9951d213be202cd84f5de00910a57624a0 doc_id: 1037855 cord_uid: bch3dacu Background When coronavirus disease of 2019 (COVID-19) became a pandemic, it was difficult to predict how it will affect lung transplant recipients. Aim of this study is to assess the mortality, influence on graft function as well as attitude towards SARS-CoV-2 vaccination among lung transplant recipients from a single center. Materials and Methods Medical data pertaining lung recipients transplanted between 2008-2021 from a single center as well as original questionnaires on the COVID-19 severity classification system and the patients’ attitude towards SARS-CoV-2 vaccination were analyzed. Graft function was assessed as spirometry and a six-minute walk test (6MWT) at least at the first post-COVID-19 visit. Results Among 29 patients with confirmed COVID-19, 6 people have died during or directly after this infectious disease. The significant decrease in spirometry and distance at 6MWT has been rarely observed in COVID-19 survivors. After vaccination, most patients reported mild symptoms with slight pain and discomfort at the injection site being the most common (51.4%). 67.7% of patients did not have any fears regarding vaccination. Others report being significantly worried about its effects (19.4% agreed to receive a vaccination anyway and 12.9% refused to be vaccinated). Conclusions COVID-19 may present significant mortality among lung transplant recipients. Short-term safety and outcomes of vaccinations among these patients seem encouraging. Authors are aware of small study group limitations and hope to research this issue further. The COVID-19 pandemic is a serious challenge for health-care systems worldwide. More than 265 million confirmed cases and more than 5.2 million deaths were documented by the World Health Organization (WHO) in the report of December 5, 2021 [1] . Clinical signs and symptoms range from mild to severe. Most often, patients complain of fever, cough and myalgia which are typical responses to viral infection. Some of them also experience: sore throat, headache, chills, nausea or vomiting, diarrhoea, ageusia and conjunctival congestion [2] . However, a significant number of patients develop critical course of an inflammatory response with dyspnoea and hypoxemia up to life-threatening organ disorders such as acute respiratory distress syndrome, shock and heart failure [3] . One group of patients at high risk of severe SARS-CoV-2 infection are those receiving immunosuppressive therapy after lung transplantation (LTx). In order to prevent the critical consequences of coronavirus disease of 2019, vaccination was introduced in lung transplant recipients [4] . The aim of the study was to examine the number of COVID-19 cases among patients after lung transplantation in a single center, as well as mortality and influence on graft function in this group of patients. Our research also included the topic of patients' attitude towards SARS-CoV-2 vaccination. A retrospective analysis was performed in a single center. The medical data of 124 lung recipients transplanted between 2008-2021 as well as original questionnaires created by the authors of the article on the COVID-19 severity classification system and the patients' attitude towards SARS-CoV-2 vaccination were analyzed. Graft function was assessed by spirometry and a six-minute walk test (6MWT). Spirometry parameters included forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC), whereas 6MWT assessment was based on obtained distance. The results were compared before COVID-19 infection, at the first visit and at six months after the illness. Among the general group of patients, the one with COVID-19 infection after lung transplantation was distinguished. There were twenty-three patients in this group, and each SARS-CoV-2 infection was confirmed by polymerase chain reaction-based assay. The characteristics of both groups of patients are shown in Table 1 . There are no significant differences in their baseline characteristics with regard to age, gender and underlying lung disease before lung transplantation. A total of 29 LTx recipients with confirmed infection by SARS-CoV-2 were included in this analysis. Six people have died during or directly after this infectious disease -so the mortality rate is 20.7%. Among 23 patients who survived, the course of the infection was assessed in three categories -mild, moderate and severe. Most often, the course of COVID-19 infection was moderate (n = 10; 43.5%), whereas mild was presented in 7 patients (30.4%) and severe in 6 patients (26.1%). Sixteen out of 23 patients did not require respiratory support during SARS-CoV-2 infection. Passive oxygen therapy was used in 4 patients (17.4%), and non-invasive ventilation in 3 patients (13.0%). Spirometry and 6MWT were used to evaluate the function of transplanted lungs in COVID-19 patients. The results were compared in two summaries -before COVID-19 infection and at the first visit after the disease, then before SARS-CoV-2 infection and at six months after the illness. The following criteria were adopted in the assessment: a significant decrease in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) was defined as a decrease of more than 200 milliliters, while in 6MWT distance -a decrease by over 50 meters. Each significant decrease in spirometry was defined as a percentage of the baseline value. Not all COVID-19 patients met the criteria for comparison of the results because they did not come to the follow-up visit or 6 months had not passed since the onset of their infection. The results of both summaries are presented in Table 2 . In follow-up 1, a significant decrease in results were compared before COVID-19 infection and at the first visit after the disease, whereas in follow-up 2 -before COVID-19 infection and at six months after the disease. After vaccination, 32 patients (29.9%) did not report any side effects. The most frequently mentioned symptoms were pain and discomfort at the vaccination site (n = 55; 51.4%), pain and discomfort at the injection site with fever occurred in 15 patients (14.0%), while the fever itself appeared in 5 patients (4.7%). None of them required hospitalization after vaccination. The original questionnaire created by the authors included questions for patients about their attitudes to vaccination. Eighty-four patients (67.7%) of the general group (n = 124) did not have any fears regarding vaccination. Others report being significantly worried about its effects -24 patients (19.4%) agreed to receive a vaccination anyway and 16 patients (12.9%) refused to be vaccinated. The most common concern indicated by patients was the various types of vaccine side effects. The function of transplanted lungs was also assessed in the vaccinated group, excluding those who had positive test for SARS-CoV-2 (n = 91). The medical data used for comparison were obtained at least one month before and at least one month after vaccination. The results were not compared for all vaccinated patients because some people missed a followup visit or the last dose was too close to the last visit so the data could not be taken into account. Among 48 patients, the significant decrease in FEV1 (defined as a decrease of more than 200 milliliters) occurred in 6 of them (12.5%). Out of 50 patients whose distance was analyzed in 6MWT before and after vaccination, 1 of them (2.0%) had the significant shortening of the distance (defined as a decrease by over 50 meters). Most often, the course of this infection among surviving lung transplant recipients was so mild that they did not require any respiratory support (69.6%). The mortality rates from recently published works were slightly higher than those obtained at our facility. Kamp The results of spirometry are presented as mean, minimal and maximal value of significant decreases as a percentage of the baseline value. The results of 6MWT are presented as mean, minimal and maximal value of significant decreases expressed in meters. * Follow-up 1 was defined as comparing the results before COVID-19 infection and at the first visit after the disease. ** Follow-up 2 was defined as comparing the results before COVID-19 infection and at six months after the disease. Abbreviations: 6MWT, 6-minute walk test; FEV1, forced expiratory volume in first second; FVC, forced vital capacity. Origin, transmission, diagnosis and management of coronavirus disease 2019 (COVID-19) COVID-19 illness in native and immunosuppressed states: A clinical−therapeutic staging proposal Vaccination and their importance for lung transplant recipients in a COVID-19 world Od kiedy mogę się zaszczepić? [Service of the Republic of Poland COVID-19 in lung transplant recipients-Risk prediction and outcomes COVID-19 in lung transplant recipients: A multicenter study COVID-19 in lung transplant recipients: A single center case series from New York City COVID-19 in lung transplant recipients: an overview of the Swedish national experience COVID-19 in Lung Transplant Recipients All of the authors have completed ICMJE disclosure forms, which are attached as supplementary file.