Outcomes of SARS-CoV-2 infection post-solid organ transplantation in the cystic fibrosis population

Background: Cystic fibrosis (CF) transplant recipients infected with SARS-CoV-2 are at high risk for hospitalization or death. We aimed to (1) assess whether time since solid organ transplantation impacts severity of SARS-CoV-2 infection and (2) to evaluate the impact of SARS-CoV-2 infection on the slope of lung function trajectory. Methods: This is a retrospective international cohort study of individuals with CF post-solid organ transplant with a confirmed SARS-CoV-2 infection between January 2020 and December 2021. The primary outcome was death or hospitalization. The secondary outcome was change in lung function trajectory following infection. To assess the impact of time from transplant on the primary outcome, logistic regression was performed while lung function trajectory was assessed using a linear mixed-effects model. Results: A total of 526 SARS-CoV-2 infections from 19 countries were recorded. The median age at time of infection was 36 years (IQR 29-44). Median time since transplant was 5.8 years (IQR 3.3-10.8). The timing of transplant relative to infection was not significantly associated with hospitalization or death (OR 0.975 CI 0.928-1.025). A higher baseline ppFEV1 was associated with a decreased odds of death or hospitalization (OR 0.989, 95% CI 0.983, 0.995). In a subgroup of participants, lung function trajectory did not change significantly in the year following SARS-CoV-2 infection. Conclusions: In a diverse global post-transplant CF population, the timing of transplantation was not significantly associated with severe outcomes following SARS-CoV-2 infection. Those with more severe lung disease were at increased risk for worse outcomes and should be monitored closely.