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

Abstract

Some patients with coronavirus disease 19 (COVID) develop serious, irreversible lung disease, including acute respiratory distress syndrome or pulmonary fibrosis. For select candidates, lung transplant is the only option to improve quality and length of life. Because of the severity of end‐stage COVID‐related lung disease, these candidates receive high allocation priority in the United States, including higher priority than many patients without COVID‐related lung disease. This study assessed whether transplant centers with a large volume of COVID‐related lung transplants experienced an increase in waitlist mortality for non‐COVID transplant candidates. Nineteen centers were included as high‐volume programs, defined as being in the top third of centers who transplanted COVID patients. Of the 2867 non‐COVID patients waitlisted at these centers, there was no significant difference in waitlist mortalities of non‐COVID transplant candidates between the pre‐COVID transplant era (January 2018–February 2020) and during the period of high COVID transplant volume (March 2020–October 2022) (subhazard ratio: .92 [95% CI = .81–1.05], p = .22). Among high volume centers, the decision to transplant and to prioritize patients with COVID‐related lung disease did not significantly impact the waitlist mortality of other candidates.