Comparative outcomes among lung transplant patients with covid-19 from omicron and non-omicron variants

SESSION TITLE: Outcomes and Opportunities: Lung Transplantation SESSION TYPE: Original Investigations PRESENTED ON: 10/10/2023 01:45 pm - 02:45 pm PURPOSE: To compare outcomes among lung transplant (LT) patients infected with B.1.1.529 (Omicron) and non-Omicron variants of COVID-19. We hypothesized that the Omicron variant would be associated with a milder course of illness and more favorable outcomes. METHODS: We included all LT patients diagnosed with COVID-19 during a two-year period (March 2020 to February 2022; n=163; median age: 58, 20-76 years; Males 58.9%). We reviewed the patient characteristics, presenting features, clinical course, and laboratory abnormalities during the acute illness. We recorded pulmonary function test data before and after COVID-19. Genetic sequencing results were available among the majority of patients after the emergence of the B.1.617.2 (Delta) variant. Among the remaining patients, the infecting variant was adjudicated based on the predominantly circulating variant using a pre-defined threshold of >97% of the sequenced isolates. The primary outcome variable was one-month survival. Secondary outcomes included: complications during the hospital course, radiological opacities, and degree of post-COVID lung function loss. RESULTS: The Omicron variant contributed to 46.6% (n=76) of infections. Baseline characteristics were similar except for body mass index (25.9 for Omicron, 28.1 for non-Omicron; p=0.006). While a similar proportion in each group had lower respiratory tract symptoms, patients with Omicron infections were less likely to present with opacities on chest radiographs (31.4% vs 54.9%; OR: 0.38, 0.18-0.78; p=0.01) or CT chest (54.3% vs 85.3%; OR: 0.2, 0.09-0.49; p<0.001). The mean C-reactive protein levels were higher in the non-Omicron group. Ferritin, LDH, ALC, and D-dimer were similar. Omicron was associated with a lower incidence of both new or worsening respiratory failure during the acute illness (17.3% vs 48.3%; 0.22, 0.11-0.47; p<0.001) and a need for ventilator support (4% vs 18.4%; 0.18, 0.05-0.66; p=0.006). However, one month survival was similar among the two groups (Omicron 93.4%, non-Omicron 88.5%; p=0.42). Post-COVID lung function loss of >10% occurred in similar frequency (Omicron 26.6%, non-Omicron 32.3%; p=0.56). The Omicron variant was less likely to lead to persistent parenchymal opacities among survivors (42.1% vs 62.1%; 0.44, 0.24-0.83; p=0.01). On the multivariate logistic regression model with the infecting variant as a covariate, male gender (adjusted OR: 4.27, 1.17-15.51; p=0.028) and lower BMI (0.84, 0.73-0.95; p=0.008) were independently associated with one-month survival. CONCLUSIONS: The frequency of significant lung function loss and one month survival is similar among patients infected with Omicron and non-Omicron variants. CLINICAL IMPLICATIONS: Regardless of the variant, patients with LT remain vulnerable to complications and death from COVID-19. These data support continued vigilance while ensuring compliance with the latest recommendations to prevent and manage COVID-19. DISCLOSURES: No disclosure on file for Amit Banga No disclosure on file for Srinivas Bollineni No relevant relationships by John Joerns No relevant relationships by Vaidehi Kaza Scientific Medical Advisor relationship with Boehringer Ingelheim Please note: May 2021 (one time) by Corey Kershaw, value=Consulting fee Scientific Medical Advisor relationship with United Therapuetics Please note: Oct 2021(one time) by Corey Kershaw, value=Consulting fee Scientific Medical Advisor relationship with Nabrivia Therapeutics Please note: April 2022 (one time) Added 11/27/2022 by Corey Kershaw, source=Web Response, value=Consulting fee No relevant relationships by Adrian Lawrence No relevant relationships by Luke Mahan No relevant relationships by Manish Mohanka No relevant relationships by John Rose No relevant relationships by Jeffrey SoRelle No relevant relationships by Lance Terada No relevant relationships by Irina Timofte No relevant relationships by Fernando Torres