Lung transplantation during the COVID-19 pandemic: Safely navigating the new “normal”

Abstract

In the United States, an overall national decline in organ transplants has accompanied the substantial burden of COVID‐19. Amidst significant regional variations in COVID‐19, lung transplantation (LTx) remains a critical life‐saving operation. Our LTx practice during the early pandemic may provide a blueprint for managing LTx in an era of continued community prevalence. Patients who underwent LTx at our institution between March 1 and May 20, 2020 were included. Recipient, operative, and donor characteristics were compared to those from our program in 2019, and COVID‐19 testing practices were evaluated for March, April, and May to understand how our practice adapted to the pandemic. Our program performed 36 LTx, 33% more than the same period in 2019. Recipient, operative, and donor characteristics during COVID‐19 were similar to those in 2019. By April 1, all donors and recipients underwent pretransplant COVID‐19 testing, all returning negative results. To date, no recipients have developed posttransplant COVID‐19. At our institution, pretransplant COVID‐19 testing, use of local donor lungs, and avoidance of donors from areas of increased community penetration supported a safe and effective LTx practice during the early COVID‐19 pandemic. Continued follow‐up is required to ensure the long‐term safety of these newly transplanted patients.

Thoracic transplantation during the COVID‐19 pandemic

“…The reasons behind these differences are unclear, however a possible explanation may be that shutdowns or severe restrictions of certain centers led to centers that did not restrict lung transplantation being able to transplant patients with lower LAS. Notably, a report from Duke University, one of the busiest lung transplant programs in the country, did not find a significant difference in LAS score in their cohort of lung transplants early in the pandemic 12 . However, this change deserves further attention as it may highlight potential opportunities for patients with lower LAS in the future to receive lung transplantation.…”

“…5,[8][9][10] As the pandemic has progressed, single centers have provided data demonstrating that transplantation of all organs can be safely done with respect to recipient outcomes. 11,12 Furthermore, centers have described how planning of ICU resources, risk stratification at a donor and recipient level as well as rigorous and efficient testing allows for safe transplantation. 13 Notably, Goff et al analyzed the SRTR data over the same time frame and demonstrated that while there was an initial decrease in transplants, the volumes have since increased.…”

“…In fact, studies based on organ procurement organization (OPO) surveys and data from March through May demonstrated a significant decline in the number of donors consented for donation as well as the actual number of donations despite increased numbers of referrals 5,8–10 . As the pandemic has progressed, single centers have provided data demonstrating that transplantation of all organs can be safely done with respect to recipient outcomes 11,12 . Furthermore, centers have described how planning of ICU resources, risk stratification at a donor and recipient level as well as rigorous and efficient testing allows for safe transplantation 13 .…”

“…Notably, a report from Duke University, one of the busiest lung transplant programs in the country, did not find a significant difference in LAS score in their cohort of lung transplants early in the pandemic. 12 However, this change deserves further attention as it may highlight potential opportunities for patients with lower LAS in the future to receive lung transplantation. It is notable that the impact on lung transplant has been different throughout the world.…”

The Year 2020 in Review: Noteworthy Literature for Thoracic Transplant Anesthesiologists

“…In response, the COVID-19 pandemic has propelled the development of specific approaches to COVID-19 for perioperative LTx management that balance concerns regarding waitlist mortality with the goal of maintaining successful outcomes. 15…”