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

BackgroundCoronavirus disease 2019 (COVID-19) social distancing measures led to a dramatic decline in non-COVID-19 respiratory virus infections, providing a unique opportunity to study their impact on annual forced expiratory volume in 1 s (FEV1) decline, episodes of temporary drop in lung function (TDLF) suggestive of infection and chronic lung allograft dysfunction (CLAD) in lung transplant recipients (LTRs).MethodsAll FEV1values of LTRs transplanted between 2009 and April 2020 at the University Medical Center Groningen (Groningen, The Netherlands) were included. Annual FEV1change 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). Respiratory virus circulation was derived from weekly hospital-wide respiratory virus infection rates. Effect modification by TDLF frequency and respiratory virus circulation was assessed. CLAD and TDLF rates were analysed over time.Results479 LTRs (12 775 FEV1values) were included. Pre-social distancing annual change in FEV1was −114 (95% CI −133– −94) mL, while during social distancing FEV1did not decline: 5 (95% CI −38–48) mL (difference pre-social distancingversusduring social distancing: p<0.001). The frequent TDLF subgroup showed faster annual FEV1decline compared with the infrequent TDLF subgroup (−150 (95% CI −181– −120)versus−90 (95% CI −115– −65) mL; p=0.003). During social distancing, we found significantly lower odds for any TDLF (OR 0.53, 95% CI 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, 95% CI 0.27–1.02; p=0.060). Effect modification by respiratory virus circulation indicated a significant association between TDLF/CLAD and respiratory viruses.ConclusionsDuring COVID-19 social distancing the strong reduction in respiratory virus circulation coincided with markedly less FEV1decline, fewer episodes of TDLF and possibly less CLAD. Effect modification by respiratory virus circulation suggests an important role for respiratory viruses in lung function decline in LTRs.