Annals of the American Thoracic Society · 2026
Retransplant- and bronchiolitis obliterans syndrome-free survival among COVID lung transplant recipients: a national cohort study.
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Courtwright Andrew M, Diamond Joshua M, Goldberg Hilary J
Аннотация
RATIONALE: There are limited longer-term follow-up data on bronchiolitis obliterans (BOS)- and retransplant-free survival among patients who underwent lung transplantation for COVID-related lung disease.
OBJECTIVES: To evaluate overall, retransplant-free, and BOS- and retransplant-free survival in a national cohort of COVID lung transplant recipients (LTRs).
METHODS: We identified all US adult LTRs in the Scientific Registry of Transplant Recipients who underwent transplant for COVID-related lung disease between August 2020 and February 2025. We used propensity score matching (PSM) to construct balanced cohorts of COVID LTRs and non-COVID group D (restrictive lung disease) LTRs, comparing overall, transplant-free, and BOS- and retransplant-free survival in the 2 populations.
RESULTS: There were 605 LTRs with COVID lung disease and 8809 with non-COVID group D diagnoses. Among patients with at least a 3-year follow-up time, survival was 79.1% in COVID LTRs and 73.7% in non-COVID LTRs. In a PSM cohort of 451 matched pairs, overall survival (LTR; hazard ratio [HR], 0.81; 95% CI, 0.60-1.10; P = .17) and retransplant-free survival (HR, 0.81; 95% CI, 0.60-1.09; P = .16) did not differ between the groups. Among non-COVID LTRs, 51 (16.0%) developed BOS, and 56 (16.3%) COVID LTRs developed BOS. Overall, 122 (33.7%) non-COVID LTRs died, were retransplanted, or developed BOS, and 110 (29.1%) COVID LTRs died, were retransplanted, or developed BOS. COVID LTRs had improved retransplant- and BOS-free survival compared to non-COVID LTRs (HR, 0.76; 95% CI, 0.58-0.98; P = .04), driven by 8 fewer deaths in the COVID LTR cohort. COVID acute respiratory distress syndrome LTRs had similar overall, retransplant-free, and BOS- and retransplant survival as COVID fibrosis LTRs.
CONCLUSIONS: In this national cohort study, there was no significant difference in overall and retransplant-free survival for COVID LTRs compared to non-COVID, restrictive lung disease LTRs at a median follow-up time of 2.5 years. COVID LTRs, however, had slightly lower hazard for BOS- and retransplant-free survival.
OBJECTIVES: To evaluate overall, retransplant-free, and BOS- and retransplant-free survival in a national cohort of COVID lung transplant recipients (LTRs).
METHODS: We identified all US adult LTRs in the Scientific Registry of Transplant Recipients who underwent transplant for COVID-related lung disease between August 2020 and February 2025. We used propensity score matching (PSM) to construct balanced cohorts of COVID LTRs and non-COVID group D (restrictive lung disease) LTRs, comparing overall, transplant-free, and BOS- and retransplant-free survival in the 2 populations.
RESULTS: There were 605 LTRs with COVID lung disease and 8809 with non-COVID group D diagnoses. Among patients with at least a 3-year follow-up time, survival was 79.1% in COVID LTRs and 73.7% in non-COVID LTRs. In a PSM cohort of 451 matched pairs, overall survival (LTR; hazard ratio [HR], 0.81; 95% CI, 0.60-1.10; P = .17) and retransplant-free survival (HR, 0.81; 95% CI, 0.60-1.09; P = .16) did not differ between the groups. Among non-COVID LTRs, 51 (16.0%) developed BOS, and 56 (16.3%) COVID LTRs developed BOS. Overall, 122 (33.7%) non-COVID LTRs died, were retransplanted, or developed BOS, and 110 (29.1%) COVID LTRs died, were retransplanted, or developed BOS. COVID LTRs had improved retransplant- and BOS-free survival compared to non-COVID LTRs (HR, 0.76; 95% CI, 0.58-0.98; P = .04), driven by 8 fewer deaths in the COVID LTR cohort. COVID acute respiratory distress syndrome LTRs had similar overall, retransplant-free, and BOS- and retransplant survival as COVID fibrosis LTRs.
CONCLUSIONS: In this national cohort study, there was no significant difference in overall and retransplant-free survival for COVID LTRs compared to non-COVID, restrictive lung disease LTRs at a median follow-up time of 2.5 years. COVID LTRs, however, had slightly lower hazard for BOS- and retransplant-free survival.