Dawlat Khan, Hammad Chaudhry, Dawood Shehzad, Haddaya Umar, David Wachira, Kelly M Pennington, Gwen Thompson
In the post-acute pandemic era, COVID-19 continues to impose a substantial clinical and economic burden on LuTRs, with elevated risks of mortality, CLAD, respiratory failure, multiorgan dysfunction, and greater resource utilization. Continued vigilance, preventive strategies, and tailored management remain essential for this high-risk population.
BACKGROUND: Lung transplant recipients (LuTRs) remain highly susceptible to severe COVID-19 due to chronic immunosuppression and graft vulnerability. Although early pandemic data described high morbidity and mortality, contemporary nationwide evidence from the post-acute pandemic period is limited.
METHODS: Using ICD-10-CM codes, we identified 9,276 adult LuTR hospitalizations in NRD-2022, of which 12.8% (n = 1185) had COVID-19. Primary outcomes included in-hospital mortality, CLAD, and 90-day readmission. Secondary outcomes included ARDS, invasive mechanical ventilation (IMV), acute kidney injury (AKI), ICU admission, shock, thromboembolic events, and resource utilization (length of stay [LOS], total charges). Multivariable logistic and linear regression models adjusted for patient- and hospital-level covariates.
RESULTS: COVID-19-positive LuTRs had significantly higher in-hospital mortality than non-COVID LuTRs (aOR 3.97; p < .001) and markedly increased odds of CLAD (aOR 10.55; p < .001). They also demonstrated higher odds of ARDS (aOR 9.36; p < .001), IMV (aOR 3.07; p < .001), ICU admission (aOR 2.82; p < .001), shock (aOR 1.85; p < .001), AKI (aOR 1.53; p < .001), and superimposed bacterial pneumonia (aOR 1.75; p < .001). Rates of tracheostomy, VV-ECMO use, pulmonary embolism, and deep venous thrombosis did not differ significantly. Ninety-day readmission rates were similar (aOR 1.06; p = .41). COVID-19 hospitalizations were associated with longer LOS (+3.72 days; p = .001) and higher total charges (+$59,350; p = .012).
CONCLUSION: In the post-acute pandemic era, COVID-19 continues to impose a substantial clinical and economic burden on LuTRs, with elevated risks of mortality, CLAD, respiratory failure, multiorgan dysfunction, and greater resource utilization. Continued vigilance, preventive strategies, and tailored management remain essential for this high-risk population.