Clinical relevance of lung transplantation for COVID-19 ARDS: a nationwide study

Abstract

BackgroundAlthough the number of lung transplantations (LTx) performed worldwide for COVID-19 induced acute respiratory distress syndrome (ARDS) is still low, there is general agreement that this treatment can save a subgroup of most severly ill patients with irreversible lung damage. However, the true proportion of patients eligible for LTx, the overall outcome and the impact of LTx to the pandemic are unknown.MethodsA retrospective analysis was performed using a nationwide registry of hospitalised patients with confirmed severe acute respiratory syndrome coronavirus type 2 (SARS-Cov-2) infection admitted between January 1, 2020 and May 30, 2021 in Austria. Patients referred to one of the two Austrian LTx centers were analyzed and grouped into patients accepted and rejected for LTx. Detailed outcome analysis was performed for all patients who received a LTx for post-COVID-19 ARDS and compared to patients who underwent LTx for other indications.ResultsBetween January 1, 2020 and May 30, 2021, 39.485 patients were hospitalised for COVID-19 in Austria. 2323 required mechanical ventilation, 183 received extra-corporeal membrane oxygenation (ECMO) support. 106 patients with severe COVID-19 ARDS were referred for LTx. Of these, 19 (18%) underwent LTx. 30-day mortality after LTx was 0% for COVID-19 ARDS transplant recipients. With a median follow-up of 134 (47–450) days, 14/19 patients are alive.ConclusionsEarly referral of ECMO patients to a LTx center is pivotal in order to select patients eligible for LTx. Transplantation offers excellent midterm outcomes and should be incorporated in the treatment algorithm of post-COVID-19 ARDS.

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

“…Among the 106 patients with CARDS referred for lung transplantation, 19 (18%) underwent lung transplantation. All patients were alive at 30-days post-transplant, and 14 (74%) were alive after a median follow-up of 134 days [ 7 ]. However, as Cypel and Keshavjee have pointed out, publication bias is possible, where only series with good outcomes are reported [ 8 ].…”

How COVID-19 Affects Lung Transplantation: A Comprehensive Review

“…Another recent study by Lang et al retrospectively evaluated 19 patients undergoing lung transplantation for COVID-ARDS. In this study, the 30-day mortality of the recipients was 0%, and 14 out of 19 patients were alive at the median follow-up of 134 (47–450) days [ 48 ]. Experts in the field suggested several factors that should be taken into consideration when assessing a patient with COVID-19-associated ARDS regarding potential candidacy for lung transplantation (based on initial experience) apart from the standard criteria for lung transplantation [ 38 , 39 , 49 , 50 ].…”

Lung Transplantation for Patients with COVID-19 Acute Respiratory Distress Syndrome

“…In Austria, 19 patients underwent transplantation to treat COVID-19 ARDS; the 30-day mortality rate was 0%. After a median follow-up of 134 days (range, 47–450 days), 14 of the patients were still alive [ 17 ]. Given that the 3-month survival was comparable to that of patients with other diseases in whom lung transplantation is indicated, COVID-19 ARDS may be an appropriate indication for lung transplantation if ongoing irreversible injury or post-ARDS lung fibrosis is likely.…”