The COVID-19 pandemic has presented considerable challenges for lung transplant (LTx) recipients, a population inherently at high risk for severe complications. Although early data from the pandemic indicated worrisome outcomes for these patients, understanding the current context of SARS-CoV-2 infections is essential to inform ongoing management strategies. The efficacy of anti-viral treatments, including Remdesivir (RDV), remains uncertain. This study aims to evaluate the effect of RDV on clinical outcomes in LTx recipients infected with SARS CoV-2, primarily those with a clinically significant disease course.

A single-center retrospective cohort study was conducted, including LTx recipients with confirmed SARS-CoV-2 infection diagnosed between January 2022 and December 2023. Patients were classified as treated with RDV if they received at least three consecutive days of therapy, typically initiated in the context of symptomatic infection with increased oxygen requirements (RDV group). The primary outcome was all-cause mortality. Secondary outcomes were ICU admission, longitudinal changes in lung function, at 3-, 6-, and 12-months post-infection, incidence of COVID-19-associated pulmonary aspergillosis (CAPA) and bacterial co-infections. A multivariable logistic regression model was used to control for cofounding factors.

Among the 130 LTx infected with SARS CoV-2, 61% (80/130) received at least 3 days of RDV. All cause of mortality was lower in the RDV group (4% 2/50) compared to the non-RDV group (15%, 12/80) (p = 0.05). Non-RDV group experienced a significant decline in forced expiratory volume in 1 second (FEV1) at 3 months post-infection compared to those in the RDV group (6% vs 3%, p=0.04). ICU admission rates, bacterial coinfection, and CAPA were similar between groups.

RDV treatment appears to improve survival and may mitigate the long-term deterioration of lung function in lung transplant recipients infected with SARS CoV-2. These findings underscore the potential of RDV as a beneficial therapy in this high-risk population and highlight the need for further investigation in larger studies.