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

Bodén, Embla LU ; Perch, Michael ; Liebermann, Regitze Hertz ; Søfteland, John Mackay ; Magnusson, Jesper M. and Lindstedt, Sandra LU (2025) In JHLT Open 10.
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... (More)

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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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
COVID-19, Denmark, lung transplantation, outcome, sociopolitical approach, Sweden
in
JHLT Open
volume
10
article number
100377
publisher
Elsevier
external identifiers
  • scopus:105014811474
  • pmid:40979526
ISSN
2950-1334
DOI
10.1016/j.jhlto.2025.100377
language
English
LU publication?
yes
id
aaccbf04-07af-4596-a142-d742e03ef8b6
date added to LUP
2025-10-03 14:43:46
date last changed
2025-10-17 16:37:49
@article{aaccbf04-07af-4596-a142-d742e03ef8b6,
  abstract     = {{<p>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.</p>}},
  author       = {{Bodén, Embla and Perch, Michael and Liebermann, Regitze Hertz and Søfteland, John Mackay and Magnusson, Jesper M. and Lindstedt, Sandra}},
  issn         = {{2950-1334}},
  keywords     = {{COVID-19; Denmark; lung transplantation; outcome; sociopolitical approach; Sweden}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{JHLT Open}},
  title        = {{Impact of COVID-19 after lung transplantation : A retrospective multicenter comparison of clinical outcomes in Denmark and Sweden}},
  url          = {{http://dx.doi.org/10.1016/j.jhlto.2025.100377}},
  doi          = {{10.1016/j.jhlto.2025.100377}},
  volume       = {{10}},
  year         = {{2025}},
}