A center experience with lung transplantation for COVID-19 ARDS

Abstract

COVID-19 can cause irreversible lung damage from acute respiratory distress syndrome (ARDS), chronic respiratory failure associated with post COVID-19 de novo fibrosis or worsening of an underlying fibrotic lung disease. Pregnant women are at increased risk for invasive mechanical ventilation, extracorporeal membrane oxygenation, and death. The Centers for Disease Control and Prevention reported more than 22,000 hospitalizations and 161 deaths for COVID-19 in pregnant women. Between August 2020 and September 2021, five patients underwent bilateral lung transplant (LT) for COVID-19 ARDS at the Henry Ford Hospital in Detroit, Michigan. De-identified demographics data, clinical characteristics, perioperative challenges, explanted lung pathology, and post-transplant outcomes are described. In post-hospitalization follow-up (median survival 273 days), we see improving endurance and excellent lung function. One patient did not survive to hospital discharge and succumbed to complications 5 months after LT. We report the first cases of bilateral LT in two postpartum women.

New Aspects of Lung Transplantation: A Narrative Overview Covering Important Aspects of Perioperative Management

“…Eleven patients were transplanted in Korea, 10 of whom were alive after a median follow-up of 322 days [ 5 ]. Five patients, including two pregnant women, were transplanted in Detroit (USA), four of whom were alive after a median follow-up of 273 days [ 6 ]. Of particular interest is the report of the Austrian experience: 39,485 patients were hospitalized for COVID-19 in Austria between 1 January 2020, and 30 May 2021, of whom 2323 required mechanical ventilation and 183 received extra-corporeal membrane oxygenation (ECMO) support.…”

Functional improvements of patients admitted to an inpatient rehabilitation facility after bilateral lung transplant due to severe COVID‐19 pulmonary disease

“…Additionally, the study design relied on information from medical documentation and/or discharge summaries from acute care hospitals and one long‐term acute care hospital that were not written in a uniform manner. Further, the total number of medical complications in acute care reported in Table 1 is likely an underrepresentation of the number of complications and more detailed explanations of specific complications experienced by patients who underwent BOLT due to COVID‐19 lung disease have been reported 1,15 . Discharge functional data for patients who transferred to acute care and did not return to IRF were not available for analysis; therefore, direct admission and discharge functional comparisons could be performed only for those patients who completed IPR.…”

“…The combination of these elements suggests that the severity of patients' functional impairments, educational needs, and need for psychosocial support is greater for those who underwent BOLT due to COVID-19 lung disease. 3,4,10,15 There remains a relative gap in our knowledge of the course of this novel group of patients admitted to IPR and there are only published case reports of patients with COVID-19 related pulmonary disease who underwent IPR following lung transplant. 15,17 The objective in reporting this retrospective review is to describe the IPR course of this patient population, identify common and potential medical complications in the postoperative period that affect functional progress, and present the outcomes of comprehensive, coordinated, interdisciplinary rehabilitation care for the management of these noteworthy patients.…”

“…Inpatient rehabilitation (IPR) provides individualized and collaborative care in the postacute care phase and has been shown to improve the functional status of posttransplant patients as well as managing their complex medical needs 8–10 . Reports have also been published describing successful IPR for patients recovering from COVID‐19, but there are limited data on the rehabilitation outcomes for patients who underwent bilateral orthotopic lung transplant (BOLT) secondary to COVID‐19 related end‐stage pulmonary disease 11–15 …”

“…Further, the procedure for bilateral lung transplant requires a greater level of postacute care medical monitoring, including larger surgical incisions that are at risk of complications, increased need for pain management and medication titrations, and greater activity restrictions. The combination of these elements suggests that the severity of patients' functional impairments, educational needs, and need for psychosocial support is greater for those who underwent BOLT due to COVID‐19 lung disease 3,4,10,15 …”