COVID-19 in Lung Transplant Recipients: A Multicenter Study

Berta Saez-Giménez; Cristina Berastegui; Miriam Barrecheguren; Eva Revilla-López; Ibai Los Arcos; Rodrigo Alonso; Myriam Aguilar; Víctor M. Mora; Isabel Otero; Juan P. Reig; Carlos A. Quezada; Virginia Pérez; Manuel Valle; Rosalía Laporta; María Deu; Judith Sacanell; Carles Bravo; Joan Gavalda; Manuel Lopez-Meseguer; Víctor Monforte


American Journal of Transplantation. 2021;21(5):1816-1824. 

In This Article

Abstract and Introduction


This study describes the clinical presentation, treatment, and outcomes of SARS-CoV-2 infection in lung transplant recipients (LTRs). This is a multicenter, retrospective study of all adult LTRs with confirmed SARS-CoV-2 infection from March 4 until April 28, 2020 in six Spanish reference hospitals for lung transplantation. Clinical and radiological data, treatment characteristics, and outcomes were reviewed. Forty-four cases were identified in that period. The median time from transplantation was 4.2 (interquartile range: 1.11–7.3) years. Chest radiography showed acute parenchymal abnormalities in 32 (73%) cases. Hydroxychloroquine was prescribed in 41 (93%), lopinavir/ritonavir (LPV/r) in 14 (32%), and tocilizumab in 19 (43%) patients. There was a strong interaction between tacrolimus and LPV/r in all cases. Thirty-seven (84%) patients required some degree of respiratory support and/or oxygen therapy, and 13 (30%) were admitted to intermediate or intensive critical care units. Seventeen (39%) patients had died and 20 (45%) had been discharged at the time of the last follow-up. Deceased patients had a worse respiratory status and chest X-ray on admission and presented with higher D-dimer, interleukin-6, and lactate dehydrogenase levels. In this multicenter LTR cohort, SARS-CoV-2 presented with high mortality. Additionally, the severity of disease on presentation predicted subsequent mortality.


The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak has been declared a pandemic due to the high number of cases worldwide. In the World Health Organization report of May 11, 2020, there were more than 4 million confirmed cases of SARS-CoV-2 infection and more than 279,000 deaths.[1] Three stages of the disease have been described: initial early infection, followed by pulmonary involvement, and finally systemic hyperinflammation.[2] Around 5%–14% of patients develop respiratory failure, and some also develop acute respiratory distress syndrome, multiorgan failure, and death.[2–5]

The published evidence regarding coronavirus disease 2019 (COVID-19) in solid organ transplant (SOT) recipients is limited to case reports and preliminary data.[6–15] Lung transplant recipients (LTRs) have the highest risk of community-acquired respiratory viral infections.[16] However, data on COVID-19 in LTRs are scarce.[9,11,17]

The aim of this study was to analyze the clinical presentation, treatment, and outcomes of COVID-19 in LTRs.