Background: Lung transplant recipients (LTR) are at increased risk of Covid-19-associated complications but limited data are available concerning long-term lung function (LF) evolution after SARS-CoV-2 infection.

Methods: We analyzed spirometry results of LTR patients followed at our institution between March 2020 and July 2022 at 3, 6 and 12 months after first SARS-CoV-2 infection.

Results: Overall, 42 cases of our cohort (70%) of LTR with Covid-19 were included in this study. Ten (17%) were excluded for short follow-up, 7 (11%) due to a first SARS-CoV-2 infection within 6 months from transplantation and 1 (2%) deceased during follow-up. Compared to baseline, forced expiratory volume in 1 second (FEV1) declined significantly at 3 months (?FEV1 -4.5%, -97mL, CI95% [-163;-31], p<0.01, n=35) but did not differ at 6 months (?FEV1 -2.2%, -57mL CI95% [-118;+4] p=0.07, n=42) and 12 months (?FEV1 -3.9%, -65mL, CI95% [-168;+39], p=0.21, n=24). Results were similar for the forced vital capacity (FVC) with a significant decline at 3 months (?FVC -4.1%, -119mL, CI95% [-200;-39], p<0.01) and 6 months (?FVC -3.2%, -103mL, CI95% [-183;-22], p=0.01) but no difference at 12 months (?FVC -3.1%, -99mL, CI95% [-238;+40], p=0.15). There was no correlation between decline of spirometry values and preexisting chronic lung allograft dysfunction (CLAD), infection during omicron variant period and intercurrent respiratory infection during follow-up. One patient (2%) developed CLAD during follow-up.

Conclusions: Spirometry values in LTR decreased at 3 months after Covid-19, but not significantly at 12 months, even in patients with a previous diagnosis of CLAD.