Impact of COVID-19 after lung transplantation: A retrospective multicenter comparison of clinical outcomes in Denmark and Sweden

JHLT Open Pub Date : 2025-08-20 DOI:10.1016/j.jhlto.2025.100377

Embla Bodén , Michael Perch , Regitze Hertz Liebermann , John Mackay Søfteland , Jesper M. Magnusson , Sandra Lindstedt

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Abstract

Background

The coronavirus disease-2019 (COVID-19) pandemic posed pronounced challenges in the care of lung transplant (LTx) recipients. Global variations in containment strategies and the introduction of messenger ribonucleic acid (mRNA) vaccines have sparked extensive debate in both scientific and public arenas.

Methods

This retrospective study compared outcomes among LTx recipients in Denmark, which implemented a more restrictive COVID-19 containment strategy, and Sweden, which adopted a less restrictive approach. A total of 318 LTx recipients with at least 1 episode of polymerase chain reaction (PCR)-confirmed COVID-19 were included. Propensity score weighting was applied to balance covariates, and survival outcomes were analyzed using weighted Cox proportional hazards and Kaplan-Meier analyses.

Results

No significant differences in mortality or risk of chronic lung allograft dysfunction (CLAD) were found between countries (hazard ratios [HR] for death, Sweden = 1.49, 95% confidence intervals [CI]: 0.68-3.26, p = 0.314; HR for CLAD, Sweden = 0.63, 95% CI: 0.32-1.25, p = 0.187). Unvaccinated patients had a significantly higher risk of death compared to vaccinated patients (HR = 3.49, 95% CI: 1.46-8.34, p = 0.005), and infections with the original Wuhan strain carried a higher risk than Omicron (HR = 3.59, 95% CI: 1.53-8.44, p = 0.003). CLAD development or progression was not significantly associated with any subgroup.

Conclusions

Despite differences in timing of infections and case load between Sweden and Denmark, clinical outcomes among infected LTx recipients were comparable. mRNA vaccination was strongly associated with improved survival. The results of the current study highlight the importance of continued vaccination efforts and tailored containment strategies in vulnerable populations.

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COVID-19对肺移植后的影响：丹麦和瑞典临床结果的回顾性多中心比较

2019冠状病毒病（COVID-19）大流行给肺移植（LTx）受者的护理带来了显著挑战。遏制战略的全球差异和信使核糖核酸（mRNA）疫苗的引入在科学和公共领域引发了广泛的争论。方法本回顾性研究比较了丹麦和瑞典LTx接受者的结果，丹麦实施了更严格的COVID-19遏制策略，瑞典采用了限制较少的方法。共纳入318例至少有1次聚合酶链反应（PCR）确诊的COVID-19患者。使用倾向评分加权来平衡协变量，并使用加权Cox比例风险和Kaplan-Meier分析分析生存结果。结果各国之间的死亡率或慢性同种异体肺功能障碍（chronic lung allograft dysfunction， CLAD）风险无显著差异（死亡风险比[HR]，瑞典= 1.49,95%可信区间[CI]: 0.68-3.26, p = 0.314； CLAD风险比[HR]，瑞典= 0.63,95% CI: 0.32-1.25, p = 0.187）。未接种疫苗的患者的死亡风险明显高于接种疫苗的患者（HR = 3.49, 95% CI: 1.46-8.34, p = 0.005），感染原武汉菌株的风险高于Omicron （HR = 3.59, 95% CI: 1.53-8.44, p = 0.003）。CLAD的发展或进展与任何亚组均无显著相关性。结论：尽管瑞典和丹麦在感染时间和病例量方面存在差异，但感染LTx受体的临床结果具有可比性。mRNA疫苗接种与存活率的提高密切相关。目前的研究结果强调了在脆弱人群中继续开展疫苗接种工作和量身定制的遏制战略的重要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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JHLT Open

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