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Combined coronary artery bypass grafting (CABG) and lung transplantation (LT) remains controversial. We sought to examine the operative course and clinical outcomes of patients who underwent concomitant CABG and LT at our center. We conducted a retrospective analysis of all patients who underwent concomitant CABG and LT between May, 2014 and September, 2022. The primary outcome was survival. Secondary outcomes included serious postoperative complications and length of hospital stay (LOS). A total of 40 patients were included in the analysis. Mean age was 66 years (IQR 50-78) and 88% of the patients were male. All patients had either underlying interstitial lung disease (92%) or chronic obstructive lung disease (8%). The mean LAS score was 54.7 (IQR 32.9-93.6); 11 (27%) patients were hospitalized at the time of LT; and 2 (5%) required ECMO as a bridge to LT. All CABG procedures were performed with a beating heart, off-pump, using endoscopically harvested saphenous vein grafts. Of the 5 patients who required circulatory support during LT, modalities included cardiopulmonary bypass (n=3) and ECMO (n=2). More than half of all patients (n=22; 55%) required bypass of ≥ 2 vessels. Survival did not differ between number of vessels bypassed; however, 1-year survival was statistically higher among patients that received bypass of the left anterior descending artery compared to those that did not (Figure 1). Complication rates were low with 3 (7.5%) patients requiring dialysis, 1 (2%) suffering from a stroke, and 3 (7.5%) requiring return to the operating room for bleeding. The median LOS was 18 days (IQR 7-70). Survival to discharge was 98%, 30-day survival was 100%, and 1-year survival was 81% (26/31). Concomitant off-pump CABG using vein grafts at the time of LT can be performed with acceptable outcomes at high-volume LT centers. However, long-term survival among patients with non-left anterior descending coronary artery disease may be reduced. [ABSTRACT FROM AUTHOR]

Critically ill patients with COVID-19 are at high risk of morbidity and mortality. This risk may be even higher among lung transplant recipients (LTxRs) as they are immunosuppressed and typically older with multiple co-morbidities. The aim of this study was to characterize the outcomes of critically ill LTxRs with COVID-19. LTxRs with COVID-19 hospitalized in the ICU between 06/01/2020 and 02/28/2021 were included and classified as alive or deceased. Baseline clinical characteristics, laboratory results, and complications were reviewed. Death due to COVID-19 was the primary outcome. Descriptive statistics were used. Twenty-five LTxRs (13 men; 8 alive, 17 deceased) were included. Median (IQR) age, interval between LTx and COVID-19 diagnosis, and duration of ICU stay was 66 years (56, 71), 27 months (10, 51), and 19 days (10, 28), respectively. Pre-existing diabetes and chronic kidney disease were common (68%, 68%). Although statistical significance was not reached due to small sample size, survivors trended toward lower levels of CRP, ferritin, and D-Dimer at ICU admission. Fewer survivors had a stroke (0% vs 6%), hemorrhage requiring transfusion (14% vs 18%), new-onset heart failure (14% vs 29%), venous thromboemboli (24% vs 33%), and renal failure requiring dialysis (25% vs 53%). At a median of 8 days after COVID-19 diagnosis, 18 (72%) LTxRs required intubation. The need for mechanical ventilation increased the risk of death 4.327-fold (p=0.054) and lowered the probability of 60-day survival (16.7% vs 71.4%, p=0.035; Figure 1). The median survival of deceased subjects was 23 days (17, 34). Most LTxRs received corticosteroids, convalescent plasma, remdesevir, and reduced immunosuppression. Among LTxRs that survived to hospital discharge, 38% (3) were discharged home, 50% (4) required acute rehabilitation, and 75% (6) were supplemental oxygen dependent. Critically ill LTxRs with COVID-19 have high morbidity and mortality. The need for mechanical ventilation portends a poor prognosis. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Multiple variants of SARS-CoV-2 have been documented throughout the COVID-19 pandemic. Mutations that lead to these variants can affect viral spread, disease severity, and the efficacy of vaccines and therapeutics. Lung transplant (LT) recipients (LTRs) are at high risk of COVID-19-related morbidity and mortality; however, disease severity may differ between SARS-CoV-2 variants. We sought to describe the clinical outcomes of LTRs with COVID-19 at different stages of the pandemic. We performed a retrospective chart review of LTRs with COVID-19 and categorized them into 4 groups according to the prevalent variant on the date of the positive test. Chi-square and non-parametric binomial exact tests were used for comparative analyses. Since March 2020, 195 LTRs at our institute developed COVID-19; the median age was 66.6 years (58.7-72); 114 (58.5%) were male; 190 (97.4%) had received a bilateral LT; 106 (54.4%) had diabetes; 63 (32.3%) were obese; and 145 (74.4%) had chronic kidney disease with an eGFR <60. The most common immunosuppressive regimen included mycophenolate mofetil, tacrolimus, and prednisone (n=142; 72.8%). The median percent predicted FEV1 was 81% (IQR 63-96) and the median time from LT to COVID-19 diagnosis was 37.3 months (IQR 18.5-66.7). Rates of hospitalization, ICU admission, need for mechanical ventilation, and death were significantly lower for the Omicron variant than the original strain, the Alpha variant, and the Delta variant. However, there was no difference in length of hospital stay, development of extrapulmonary end-organ dysfunction, or persistent drop in spirometric flows (Table 1). Lastly, the utilization of vaccination and monoclonal antibodies grew over time and likely contributed to reduced COVID-19 severity in the latter part of the pandemic. COVID-19 continues to drive morbidity and mortality among LTRs; however, the severity of disease is lower with the omicron variant. [ABSTRACT FROM AUTHOR]