Infectious Complications of Lung Transplant for COVID-Associated Lung Injury (CALI): A Single Center Case-Control Cohort Study.

BACKGROUND: Lung transplantation is one of the only options for patients with severe COVID-19-associated lung injury (CALI). Studies on patients who received a lung transplant for CALI have, to date, not looked at the infectious outcomes.

METHODS: After IRB approval, a retrospective case-control cohort study, matched 1:1, collected data on patients who underwent lung transplantation for CALI (case) and for non-COVID-19 end-stage lung disease (control) between June 1, 2020 and April 1, 2022 at a large academic hospital in Chicago. We assessed infectious complications and other key outcomes pre-transplant and for one-year post-transplant.

RESULTS: Among 78 subjects (39 CALI and 39 matched control lung transplant patients), those in the CALI cohort were less likely to be vaccinated pre-transplant and were more likely to have diabetes, obesity, to not be ambulatory and to require pre-transplant ECMO and mechanical ventilation. Patients transplanted for CALI had higher rates of infection pre-transplant (66.7% vs 15.4% of patients in the control) and in the first 30 days post-transplant (43.6% vs. 20.5%). Numbers and types of infection were similar in both groups at other time points. One year mortality was similar (12.8% vs. 10.3%) for CALI and control populations, respectively.

CONCLUSIONS: Patients who received a lung transplant for CALI are more deconditioned with prolonged hospital stays and experience more infectious complications immediately pre- and post-transplant. Infections due to MDROs are important contributors to morbidity and mortality in this population and antimicrobial stewardship is urgently needed.