ABSTRACT
Rationale: The emergence of the novel SARS-CoV-2 has caused a global pandemic costing the lives of thousands of people. In the US, COVID-19 is now the third leading cause of death among those aged 45 through 84. Lung transplant (LTx) recipients may be at increased risk for fulminant novel SARS-CoV-2 COVID-19 infection due to their immunosuppressed state. Within solid organ transplant (SOT) recipients, the reported mortality rate has ranged from 5% to 40%. Observational studies of LTx recipients have noted a mortality rate of 10% to 34%. To further understand the mortality rate in LTx recipients, we retrospectively evaluated LTx patients at our center with COVID-19. Method: We identified LTx recipients infected with COVID-19 by nasopharyngeal swab at our institution in the Bay Area. Baseline demographics and clinical data were obtained through review of the electronic medical record (EMR) from 3/20/2020 to 12/18/20. Results: Eighteen LTx recipients were diagnosed with COVID-19 infection. The mean age was 55.1 years (SD ± 3.0) and the majority were male (Table 1). Eightynine percent of patients had 2 or more comorbidities, which included hypertension, diabetes, coronary artery disease, and chronic kidney disease. Clinical presentation ranged from mild to severe, 11% of patients were monitored at home and 89% required hospitalization. Of those hospitalized, 50% were treated in the intensive care unit (ICU). The survival rate of COVID-19 in this population was 94%. One patient who recovered from COVID-19 later died in hospice care related to other comorbidities. Conclusion: Lung transplant recipients infected with COVID-19 were mostly male and most had two or more comorbidities. Most patients had severe infection requiring hospitalization and of these, half necessitated ICU level care. The overall survival rate, however, was higher than has been reported in LTx recipients at other centers. Favorable survival outcomes may be due to disease education and prompt access to healthcare in this LTx population. Additionally, during this study period, the Bay Area did not experience the same overwhelming surge of COVID-19 cases that has been seen in other regions of the United States. Further studies are needed to evaluate factors affecting COVID-19 mortality rate in LTx patients. .
ABSTRACT
Purpose Lung transplant (LTx) recipients may be at increased risk for fulminant novel SARS-CoV-2 COVID-19 infection due to their immunosuppressed state. Additional risk factors, outcomes, and optimal management of COVID-19 in LTx recipients is unknown. Methods We identified LTx recipients infected with COVID-19 by nasopharyngeal swab in our institution. Baseline demographics and clinical data were obtained through review of the electronic medical record (EMR) from 3/20/2020 to 10/25/2020. Results Ten LTx recipients were diagnosed with COVID-19 infection. Disease course and management details are described in Table 1. Mean age was 57.5 ± 8 years, 50% were women (n = 5), and 70% self-identified as Latinx, 66% had a high school diploma or lower education. Medicare or Medicaid was the primary insurance in 60% (n = 6). Mean household size was 3.2 ± 1.5 persons. Forty percent (n = 4) had mild symptoms that progressed to fulminant hypoxemic respiratory failure at 9-10 days from symptom onset. Ninety percent (n = 9) required hospitalization with an average length of stay 14.8 ± 12. Sixty percent (n = 6) were treated in the intensive care unit (ICU), 40% (n = 4) requiring mechanical ventilation. COVID-19 specific therapies included remdesivir (80%, n = 8), dexamethasone (60%, n = 6), and convalescent plasma (50%, n = 5). Mycophenolate mofetil (MMF) was reduced or held in 60% (n = 6) of recipients. One recipient who recovered later died in hospice care from other comorbidities. Conclusion Most LTx recipients infected with COVID-19 had severe complications, with a high proportion requiring ICU admission and mechanical ventilation. Though, mortality was relatively low. Adjustments to immunosuppression included reduction in MMF and steroid augmentation. Similar to the general US population, there is a disproportionate impact of COVID-19 infection in Latinx LTx recipients that may be related to social factors such as residing in multi-generational households.
ABSTRACT
Purpose The COVID-19 pandemic accelerated the need to develop remote monitoring of graft function in lung transplant (LT) recipients. While home spirometry has been used previously in LT, long-term engagement has been poor. We aimed to improve engagement and allow efficient data and symptom collection using Bluetooth enabled home spirometers coupled with a digital chatbot. Methods We implemented an automated, chat-based mobile health intervention via text message or email paired with Bluetooth-enabled hand-held spirometers. The chatbot engaged LT recipients weekly in a personalized, automated chat with symptom assessment, education modules, and spirometer data collection. Clinical team members received automatic notification of concerning symptoms or FEV1 declines of >10%. The correlation between home spirometry FEV1 values and lab-based values were assessed with Pearson's coefficient. Results We mailed home spirometers to 424 patients. Between 5/4/2020 and 10/21/2020, 311 patients enrolled in the automated chat and, of these, 273 patients submitted ≥1 FEV1 measure, (median 13;IQR 6-23) over 24 weeks. The largest drop in FEV1 engagement came after the first week in each patient's chat experience;65% of those that submitted an FEV1 at baseline entered a value at week one and 72% at week two. However, after this initial decline, engagement remained stable through 24 weeks (57-72%, Figure 1.A). Home spirometry FEV1 correlated closely with in-lab spirometry (rho = 0.94) (Figure 1.B) Conclusion