Lung Transplant as a Treatment for Patients with End-Stage Respiratory Failure Due to COVID-19

Urlik, Maciej; Stącel, Tomasz; Latos, Magdalena; Pasek, Piotr; Pióro, Anna; Zawadzki, Fryderyk; Gmerek, Marta; Księżopolska, Paulina; Przybyłowski, Piotr; Ochman, Marek

doi:10.1016/j.transproceed.2022.03.017

Cited by 2 publications

(4 citation statements)

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“…Finding the right donor for these patients can be very di cult, for several reasons. First, there was a signi cant collapse in terms of available organs around the world during the COVID-19 pandemic [18,19] and Poland was no exception in this regard [9,19,20]. Second, due to the upward shift of the diapharm in patients with COVID-19, there is rapidly progressive brosis and a loss of tidal volumes, which makes it extremely di cult to nd suitable donors for LT [2,10,21].…”

Section: Discussionmentioning

confidence: 99%

“…An analysis of all 119 consecutive patients with COVID-19 referred to our center for LT has already been published by Urlik at al. [9]. The aim of the present study was to perform a subgroup analysis of our patients awaiting LT on ECMO support and present ethical and moral dilemmas associated with the process of treatment in this particular group of patients.…”

Section: Introductionmentioning

confidence: 99%

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Ethical dilemmas in COVID-19 patients awaiting lung transplantation on extracorporeal membrane oxygenation

Trejnowska

Urlik

Ochman

et al. 2023

Preprint

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Background: Extracorporeal membrane oxygenation (ECMO) may serve as a bridge to successful lung transplantation (LT) in selected patients with coronavirus disease 19 (COVID- 19) pneumonia. Compliance with the recognized LT criteria however, may be impossible to be met in this particular and extremely challenging group of patients. This situation create huge moral and ethical dilemmas. To indicate this, we decided to explore this difficult topic and present how non-compliance to the recognized LT criteria enabled us to perform three successful and life-saving LT procedures in COVID-19 patients. Methods: Data of all consecutive patients on ECMO support as rescue treatment for COVID- 19 pneumonia, awaiting LT at SCHD between October 1, 2020 and May 31, 2021 were reviewed. Results: 18 patients on ECMO entered the list for LT at SCHD (mean age: 40.5 ± 5.6 years, range 28–48 years). Mean duration of ECMO was 29.6 ± 15.5 days (range 6–71 days). 11 patients died: either during LT (n = 3), post-LT (n = 1), or on ECMO awaiting LT (n = 7). The overall mortality rate in this group was 61.1%. Survivors (n=7) were either successfully transplanted (n = 3) or weaned from ECMO (n = 4). In the medical literature, there are several enthusiastic case reports describing successful LTs, however there might be a significant publication bias in this area, as failed procedures probably remain largely under-reported. There are no data to indicate the right time for LT in post-COVID-19 patients. Experts in this field require minimum recovery period of 4 weeks to exclude native lung recovery, active participation in physical rehabilitation and the possibility of providing informed consent to proceed with LT. All these conditions were impossible to be met in our patients awaiting LT on ECMO support. Conclusions: Traditional lung transplantation criteria are difficult to be applied in COVID-19 patients requiring ECMO support due to medical and ethical reasons. Performing LT without prior consent of patients violates the ethical principles of solid organ transplants, but may be life-saving in some patients.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Ethical dilemmas in COVID-19 patients awaiting lung transplantation on extracorporeal membrane oxygenation

Trejnowska

Urlik

Ochman

et al. 2023

Preprint

Self Cite

View full text Add to dashboard Cite

show abstract

“…LT recipients with a primary diagnosis of COVID-19 had a slightly improved functional status at listing (p < 0.001) and time of transplant (p < 0.001), and experienced slightly lower arterial pressures at transplant (median 25 mmHg IQR [20][21][22][23][24][25][26][27][28][29][30] vs. 36 ; p < 0.001) than did non-COVID-19 ARDS LT recipients (Table 2).…”

Section: Pre-transplant Clinical Variablesmentioning

confidence: 99%

“…[1] Current literature regarding LT in the setting of COVID-19 is limited. To date studies have reported on the preliminary experience of LT in the setting of COVID-19 in the United States, [20] have evaluated racial disparities in LT recipients with disease processes associated with COVID-19, [21] and have concluded that patients with irreversible lung damage to COVID-19 suffer high mortality if they do not receive LT. [22] Though LT has long been therapeutic for patients with ARDS, clinical presentations of COVID-19 and non-COVID-19 ARDS patients differ. [23] Moreover, while LT is established as a viable treatment for refractory non-COVID-19 ARDS, the differences in clinical presentation and outcomes of COVID-19 and non-COVID-19 ARDS LT recipients have not been well described but can guide future practice.…”

Section: Introductionmentioning

confidence: 99%