Lung Transplantation for Severe Post–coronavirus Disease 2019 Respiratory Failure

Abstract

Background. The coronavirus disease 2019 (COVID-19) pandemic has resulted in >72 million cases and 1.6 million deaths. End-stage lung disease from COVID-19 is a new and growing entity that may benefit from lung transplant; however, there are limited data on the patient selection, perioperative management, and expected outcomes of transplantation for this indication. Methods. A systematic review of the literature was performed with searches of MEDLINE and Web of Science databases as well as the gray literature. All manuscripts, editorials, commentaries, and gray literature reports of lung transplantation for COVID-related respiratory failure were included. A case from the University of Virginia is described and included in the review. Results. A total of 27 studies were included: 11 manuscripts, 5 commentaries, and 11 gray literature reports. The total number of transplantations for COVID-related lung disease was 21. The mean age was 55±12 years, 16 (76%) were male individuals, and the acuity was high, with 85% on extracorporeal membrane oxygenation preoperatively. There was a 95% early survival rate, with 1 additional late death. There is growing histopathologic evidence for permanent structural damage with no replicating virus at the time of transplantation. Conclusions. Bilateral lung transplantation is an effective treatment option with reasonable short-term outcomes for patients with end-stage lung failure secondary to COVID-19. However, specific considerations in this new population require a multidisciplinary approach. As we move into the second wave of the COVID-19 global pandemic, lung transplantation will likely have a growing role in management of these complex patients.

A center experience with lung transplantation for COVID-19 ARDS

“…The first report in March 2020 described three Chinese patients that underwent successful bilateral LT for COVID-19 ARDS [ 4 ]. Others reported on their experience from centers in China, United States, Canada, Italy, Austria, and India [ [4] , [5] , [6] , [7] , [8] , [9] ]. The largest single center in the United States described 100% survival at 30-days post-bilateral LT for COVID-19 ARDS in 3 patients [ 10 ].…”

“…The largest single center in the United States described 100% survival at 30-days post-bilateral LT for COVID-19 ARDS in 3 patients [ 10 ]. A recent review of published and unpublished literature described the effectiveness of LT in 21 patients with COVID-19 ARDS [ 7 ]. Additional cases of LT have been performed but are unreported.…”

Lung Transplantation in a Patient With COVID-19-Associated Acute Respiratory Failure

“…More than 72 million cases and 1.6 million deaths worldwide have been caused by the COVID-19 pandemic as of December 2020 [ 1 ]. A significant number of people develop severe symptoms leading to acute respiratory distress syndrome (ARDS) ultimately requiring mechanical ventilation and prolonged intensive care unit (ICU) [ 2 ].…”

“…The patient mentioned here required VV-ECMO support for 33 days until a bilateral lung transplant was performed on day 71 after the initial COVID infection. The postoperative survival rate after lung transplantation despite being on ECMO has been reported to be as high as 95% [ 1 ]. On the other hand, the 90-day in-hospital mortality after the initiation of ECMO in patients with ARDS has been reported to be 38% (95% CI, 34.6-41.5) [ 7 ].…”

A pandemic of acute respiratory distress syndrome—role of lung transplant in coronavirus disease-2019–associated respiratory failure

“…Hawkins et al performed a review of all cases of lung transplantations that were conducted in patients with respiratory failure due to COVID-19 and published before December 15, 2020 [ 39 ]. The review had 21 patients, out of which 17 patients were transplanted using ECMO as bridging strategy.…”