1-Year Outcomes of Lung Transplantation for Coronavirus Disease 2019–Associated End-Stage Lung Disease in the United States

Abstract

Background Lung transplantation can provide quality of life and survival benefits in patients with COVID-19 associated end-stage lung disease. Characteristics and outcomes of these lung transplant recipients are limited to mostly single center experiences or provide a short-term follow up. Methods Characteristics of deceased donors and adult lung transplant recipients for COVID-19 associated end stage lung disease between August-2020 and June-2022 were analyzed using the de-identified United Network for Organ Sharing database. Post-transplant patient survival of COVID recipients was analyzed and compared with non-COVID recipients. Secondary outcomes were length of hospitalization, post-transplant complications, and rates of organ rejection post-transplant. Results During the study period, 400 lung transplants for COVID associated end-stage lung disease, comprised 8.7% of all lung transplants performed in US. In the COVID group, Hispanic males received lung transplants at significantly higher rates. The COVID group was younger and had higher need for ICU stay, mechanical ventilation, hemodialysis, extracorporeal membrane oxygenation support, receipt of antibiotics pre- lung-transplant. They also had a higher Lung Allocation Score (LAS), with a shorter waitlist time and received more double lung transplants compared to non-COVID recipients. Post- transplant, the COVID cohort had longer length of hospital stay, with similar one-year overall patient survival (COVID 86.6% vs non-COVID 86.3%, P = 0.45). Post-transplant, COVID-19 associated deaths were 9.2% of all deaths among lung-transplant recipients during the study period. Conclusions Lung transplantation offers a safe and effective option for carefully selected patients with end-stage lung disease from prior COVID-19, with short-term and long-term outcomes similar to lung transplant recipients of non-COVID etiology.

The impact of high volumes of COVID‐related lung transplant on waitlist mortality for non‐COVID candidates in the United States

“…Similar to other studies, we found that the number of transplants for COVID‐related lung disease increased steadily beginning in March 2021 1,7 . At the peak, 15 patients a week were being transplanted for COVID.…”

“…For example, in a US national cohort study, there was no difference in 3‐month survival between candidates transplanted for COVID versus non‐COVID‐related lung disease 1 . Similarly, no significant difference was found in 1 year survival outcomes between COVID and non‐COVID transplant recipients 7 . Based on this experience, clinicians have suggested that lung transplant be considered for patients with other forms of postinfectious ARDS and fibrosis, including in future pandemics 8 …”

“…and non-COVID transplant recipients. 7 Based on this experience, clinicians have suggested that lung transplant be considered for patients with other forms of postinfectious ARDS and fibrosis, including in future pandemics. 8 This conversation, however, has primarily focused on the potential benefits of transplant for patients with COVID-related ARDS rather than the implications for patients with standard advanced lung diseases, such as pulmonary hypertension, cystic fibrosis, or interstitial lung disease.…”

Multidisciplinary Management Strategies for Long COVID: A Narrative Review

“…It is crucial to ensure that appropriate time is allowed for the lungs to recover before patients are considered for lung transplant, especially in patients with organizing pneumonia who have the potential to recover over time, although this recovery may take months [45]. About 8.7% of lung transplants performed in the US between August 2020 and June 2022 were for COVID-related lung disease [3,46]. Whether this number will increase in the future is dependent on the emerging SARS-COV-2 variant characteristics and the effect of herd immunity.…”