Impact of COVID-19 social distancing measures on lung transplant recipients: decline in overall respiratory virus infections is associated with stabilisation of lung function

Abstract

Background

COVID-19 social distancing measures led to a dramatic decline in non-COVID respiratory virus (RV) infections, providing a unique opportunity to study their impact on annual FEV₁ decline, episodes of temporary drop in lung function (TDLF) suggestive of infection and chronic lung allograft dysfunction (CLAD) in lung transplant recipients (LTR).

Methods

All FEV₁ values of LTR transplanted between 2009-April 2020 were included. Annual FEV₁ change was estimated with separate estimates for pre- social distancing (2009/2020) and the year with social distancing measures (2020/2021). Patients were grouped by individual TDLF frequency (frequent/infrequent). RV circulation was derived from weekly hospital-wide RV infection rates. Effect modification by TDLF frequency and RV circulation was assessed. CLAD and TDLF rates were analyzed over time.

Results

479 LTR (12 775 FEV₁ values) were included. Pre- social distancing annual change in FEV₁ was −114 mL [95%CI; −133; −94], while during social distancing FEV₁ did not decline: +5 mL [−38; 48] (difference pre- versus during social distancing: p<0.001). The frequent TDLF subgroup showed faster annual FEV₁ decline compared to infrequent TDLF (−150 mL [−181; −120] versus −90 mL [−115; −65] p=0.003). During social distancing, we found significantly lower odds for any TDLF (OR 0.53 [0.33; 0.85], p=0.008) and severe TDLF (OR 0.34 [0.16; 0.71] p=0.005) as well as lower CLAD incidence (OR 0.53 [0.27; 1.02] p=0.060). Effect modification by RV circulation indicated a significant association between TDLF/CLAD and RVs.

Conclusion

During social distancing the strong reduction in RV circulation coincided with markedly less FEV₁ decline, fewer TDLFs and possibly less CLAD. Effect modification by RV circulation suggests an important role for RVs in lung function decline in LTR.

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Footnotes

This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.

Conflict of interest: Dr. De Zwart has nothing to disclose.

Conflict of interest: Dr. Riezebos has nothing to disclose.

Conflict of interest: Dr. Lunter has nothing to disclose.

Conflict of interest: Dr. Neerken has nothing to disclose.

Conflict of interest: Dr. Van Leer-Buter has nothing to disclose.

Conflict of interest: Dr. Alffenaar has nothing to disclose.

Conflict of interest: Dr. Van Gemert has nothing to disclose.

Conflict of interest: Dr. Erasmus has nothing to disclose.

Conflict of interest: Dr. Gan has nothing to disclose.

Conflict of interest: Dr. Kerstjens has nothing to disclose.

Conflict of interest: Dr. Vonk has nothing to disclose.

Conflict of interest: Dr. Verschuuren has nothing to disclose.