Covid-19 Pneumonia in Lung Transplant Recipients Admitted to the Intensive Care Unit: the COLT-ICU French Multicenter Retrospective Cohort Study

Background Lung transplant (LTx) recipients are at high risk for severe COVID-19. Few data on morbidity and mortality in LTx recipients admitted to the intensive care unit (ICU) for COVID-19 are available. Methods We conducted a multicenter retrospective study in the nine accredited adult LTx centers in France from March 2020 to December 2022. The primary objective was to identify risk factors for mortality in LTx recipients admitted to the ICU for severe COVID-19. We also described treatment strategies before and during the ICU stay, ventilation strategies, and medium-term changes in lung function tests in survivors. Results Of the 84 included patients, 39 (46.4%) died in the ICU. Factors independently associated with ICU mortality were time >30 months since LTx (OR, 5.52; 95%CI, 1.66–20.30; P =0.007) and intubation (OR, 4.90; 95%CI, 1.39–19.73; P =0.017). Among the 54 intubated patients, mortality was 59% both in those with first-line intubation (n=22) and in those with intubation after failure of non-invasive strategies (n=32). Mortality was 80% with intubation after ≥5 days of non-invasive strategies. The use of specific anti-SARS-CoV-2 treatments was not different between survivors and non-survivors. Lung function tests worsened significantly after the infection. Conclusions The ICU mortality rate among LTx recipients with severe COVID-19 pneumonia was high. Although intubation was associated with mortality, the very high mortality when intubation was delayed by ≥5 days indicates a need for rapidly identifying those patients who will not recover with non-invasive strategies. Specific anti-SARS-CoV-2 treatments were not associated with decreased mortality.