Lung Transplantation for Patients With COVID-19

Abstract

The COVID-19 pandemic has caused acute lung injury in millions of individuals worldwide. Some patients develop COVID-related acute respiratory distress syndrome (CARDS) and cannot be liberated from mechanical ventilation. Others may develop post-COVID fibrosis resulting in substantial disability and need for long-term supplemental oxygen. In both of these situations, treatment teams often inquire about the possibility of lung transplantation. In fact, lung transplantation has been successfully employed for both CARDS and post-COVID fibrosis in a limited number of patients worldwide. Lung transplantation following COVID infection presents a number of unique challenges that transplant programs must consider. In those with severe CARDS, the inability to conduct proper psychosocial evaluation and pre-transplant education, marked deconditioning from critical illness, and infectious concerns regarding viral re-activation are major hurdles. In those with post-COVID fibrosis, our limited knowledge about the natural history of recovery following COVID-19 infection is problematic. Increased knowledge of the likelihood and degree of recovery following COVID-19 acute lung injury is essential for appropriate decision making with regard to transplant. Transplant physicians must weigh the risks and benefits of lung transplant differently in a post-COVID fibrosis patient who is likely to remain stable or gradually improve in comparison to a patient with a known progressive fibrosing interstitial lung disease (fILD). It is clear that lung transplantation can be a life-saving therapeutic option for some patients with severe lung injury from COVID-19 infection. In this review, we discuss how lung transplant providers from a number of experienced centers approach lung transplantation for CARDS or post-COVID fibrosis.

Solid Organ Transplantation in SARS-CoV-2 Recovered Transplant Candidates: a Comprehensive Review of Recent Literature

“…on MV and ECMO • On 100 d of ECMO • On 90 d of ECMO Uneventful 3 to 5 mos Croci GA et al, March 2021 [ 31 ] 1 Mild illness 2 mos. back Positive 6 mos Gok et al, April 2021 [ 72 ] 2 • 69/M • 63/M • Severe, ARDS on d 0 • ARDS on d 6 • Noninvasive ventilation d 57 • d 68 • 41 d • 34 d • Positive 55 d • Positive 41 d 30 d Bharat A et al, May 2021 [ 30 ••] 12 Median:48 yr (IQR 41–51) Sex: M:9 F:3 All had critical COVID-19 All on ECMO All were on life support All patients weaned off ECMO Short follow-up Oh DK et al, May 2021 [ 29 ] 1 55/F Critical COVID-19; ARDS On ECMO • 88 d • 49 d of ECMO Uneventful 3 mos King CS et al, Sept 2021 [ 28 ] 1 37/F Critical COVID-19 On ECMO for 7 wks • 10 wks. after COVID-19 illness • RT-PCR negative Uneventful D 16 Heart transplantation Soquet et al, Sept 2020 [ 33 ] …”

“…The first case series of LT in a SARS-CoV-2 recovered patient was reported in a US study, where 3 patients suffering from irreversible lung injury benefited from LT [24]. There are also a few reports of successful LT in other nations [25][26][27][28]. In general, conducting a LT in a recipient after recovered SARS-CoV-2 infection is relatively difficult compared to other SOT.…”

A center experience with lung transplantation for COVID-19 ARDS

“…Additional cases of LT have been performed but are unreported. A query of the United Network for Organ Sharing identified COVID-19 as the diagnosis in over 200 LT cases through November 2021 since the United Network for Organ Sharing implementation of COVID-19 as a diagnosis in October 2020 [ 11 ].…”

How COVID-19 interacts with interstitial lung disease

“…Finally, lung transplant has been performed for post-COVID-19 fibrosis [34], but there is significant difficulty in selecting the right patients at the best time, given that the natural course of the disease remains unknown [30]. A review of currently available literature suggests waiting for 8 weeks without clinical improvement [35]; patients are often bridged with extracorporeal membrane oxygenation during this time [36]. The national statistics for cardiothoracic transplant in the UK in 2020-2021 have not yet been published so it is not known how many patients have undergone this procedure.…”