Post–Lung Transplantation Outcomes and Ex Vivo Histopathological Findings in Severe Post-Covid-19 Pulmonary Disease—A Single-Center Experience

Abstract

Background A significant proportion of patients with severe and persistent Coronavirus Disease 2019 (COVID-19) require continuous ventilatory support and occasional extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS). Lung transplantation is a treatment option for patients who develop severe ARDS. Methods Our lung transplant database was retrospectively reviewed for patients who underwent lung transplantation for COVID-19 pulmonary disease at Memorial Hermann Hospital, Texas Medical Center, Houston, Texas from January 2020 to March 2022. We evaluated outcomes of patients who were followed in our clinic at least six months post-transplant. Pre-transplant patient characteristics, COVID-19 related treatment, histopathology results, and post discharge course were evaluated. Results Among a total of 13 lung transplant recipients, six consecutive patients were identified who had a minimum of six-month follow-up post-lung transplantation. The average age of patients was 55 years old with a male predominance. Median time to transplantation was 111 days. All six patients had significant post-infectious complications due to COVID-19 before transplant. Histopathological findings from explanted lungs showed a predominance of fibrotic change. There were no reported cases of rejection or graft dysfunction. Five patients had minimal to no post-transplant infectious complications. One patient died 218 days post-transplant from infectious complications. Conclusions Five out of six lung transplant recipients at our institution have demonstrated excellent long-term outcomes after index hospitalization for a mean follow up of 13 months post-lung transplantation. Lung transplantation for lung fibrosis due to COVID-19 is an acceptable salvage treatment option. Larger studies are warranted to confirm the findings.

Hyaluronan in the pathogenesis of acute and post-acute COVID-19 infection

“…The severity of ARDS and the duration of illness seem to be important predictors of pulmonary fibrosis in COVID-19 [ 119 , 120 ]. For a subset of these patients, lung transplantation is the only treatment option [121] . In these patients, extensive fibrotic lung injury presents on average 79 days from the time of the first COVID-19 symptoms or first positive test for SARS-CoV-2 [ 122 , 123 ].…”