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Lung transplant recipients are at particular risk for severe pulmonary infections, and before SARS-CoV-2 vaccines and antivirals became available, COVID-19–related mortality exceeded 30%. How do such transplant recipients fare with Omicron infections, which generally have a mild course? Researchers in Germany analyzed data from lung transplant recipients at 8 centers between January 1 and March 20, 2022 (median age, 56; 24% with chronic lung allograft dysfunction). Among 218 patients with COVID-19 caused by Omicron (BA.1 or BA.2), 86% had received a complete primary vaccination series (most commonly with BNT162b2); of these, 23% had received at least one booster dose. Among 129 patients with known antibody status, 70% had not mounted a response to vaccination. Antiviral therapy (most often sotrovimab) was given to 166 patients within the first 7 days of illness and to 28 patients ≥7 days after symptom onset; 24 received no antiviral treatment.
In all, 16% of patients developed severe or critical COVID-19 and 6% died a median 27 days after disease onset. In multivariate regression analysis, only age at infection and renal insufficiency were associated with a severe or critical disease course. Antiviral treatment, vaccination status, and response to vaccination did not affect these outcomes.
Kneidinger N et al. Outcome of lung transplant recipients infected with SARS-CoV-2/Omicron/B.1.1.529: A nationwide German study. Infection 2022 Sep 9; [e-pub]. (https://doi.org/10.1007/s15010-022-01914-8)
Comment
Omicron infections clearly may not always follow a benign course in lung transplant recipients, who are still at considerable risk for critical disease or death. Minimizing exposure through mask-wearing and complete COVID-19 vaccination of household contacts are key for these highly immunocompromised individuals, in whom vaccination and antiviral treatments do not appear to be effective.