Abstract
Vaccination reduces COVID-19-related morbidity and mortality in the general population, however, the response to vaccination is attenuated among immunosuppressed lung transplant recipients (LTR). Boyarski et al noted that 61% of LTR had no serologic response to the first or second dose of mRNA vaccines, with an additional 31% only responding to the second dose. We sought to compare the impact of vaccination status on COVID-19-related morbidity and mortality in LTR.
We conducted a retrospective chart review of LTR with COVID-19 that did not receive Tixagevimab-Cilgavimab (Tix-Cil) prophylaxis. We compared outcomes based on vaccination status using chi-square and binomial exact tests.
Between March 2020 and August 2022, 195 LTR developed COVID-19, 24 received Tix-Cil and were excluded from the analysis. The median age was 66.6 (58.8-71.9), 100 (58.5%) were male, 166 (97.1%) had a bilateral lung transplant, 91 (53.2%) had diabetes, 55 (32.2%) were obese, and 126 (73.7%) had chronic kidney disease with an eGFR <60. The most common immunosuppressive regimen included mycophenolate mofetil, tacrolimus, and prednisone (124 (72.5%)). The median percent predicted FEV1 was 78% (IQR 62, 94) and the median time from LT to COVID-19 diagnosis was 38.3 months (IQR 20.3, 66.9). LTR with COVID-19 that received at least 2 doses of the mRNA vaccines were less likely to be hospitalized compared to their unvaccinated counterparts. However, 2 vaccine doses alone did not reduce ICU admission, intubation, or mortality. LTR with COVID-19 that received >2 vaccines were less likely to be hospitalized, admitted to the ICU, or intubated, and had a lower mortality.
Two doses of mRNA vaccines reduced COVID-19-related hospitalization among LTR with COVID-19; additional vaccine doses were needed to reduce risk of ICU admission, intubation, and death.