COVID-19 caused by the Omicron variant in lung transplant recipients: a single center case series

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Key findings

• C-reactive protein (CRP) >41.8 mg/L, interstitial lung disease (ILD) as primary disease, and combined pulmonary fungal infection are high-risk factors for developing severe disease in lung transplant recipients (LTRs) with coronavirus disease 2019 (COVID-19) caused by the Omicron variant. CD4⁺ T lymphocyte count <404 cells/µL may predict mortality risk.

What is known and what is new?

• We have known that solid organ transplant recipients who contracted severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) are susceptible to severe disease mainly due to immunosuppressive treatment. Although recent reports have highlighted reduced morbidity and mortality associated with the Omicron variant, its impact on LTRs remains substantial. However, a limited number of studies on LTRs have been reported, especially from Chinese experience.

• In this study, we showed that LTRs displayed an increased vulnerability to combined lung bacterial or fungal infections following Omicron infection. CRP >41.8 mg/L, ILD as primary disease, and combined pulmonary fungal infection are recognized as high-risk factors for developing severe disease after Omicron infection. CD4⁺ T lymphocyte count <404 cells/µL may predict mortality risk.

What is the implication, and what should change now?

• Although COVID-19 is no longer classified as a Public Health Emergency of International Concern by World Health Organization, it is still mutating and causing death, especially in immunocompromised people.

• We emphasize the importance for dynamic surveillance and timely intervention measures in the care of LTRs affected by SARS-CoV-2, in light of the challenges posed by the Omicron variant or other variants in the future.

Publication: Zhao L, Guo L, Xing B, Zhang Y, Chen M, Chen W. COVID-19 caused by the Omicron variant in lung transplant recipients: a single center case series. J Thorac Dis 2025;17(2):576-592. doi: 10.21037/jtd-24-1314