Lung transplantation for the treatment of irreversible acute respiratory distress syndrome

Abstract

Background Despite advances in critical care for acute respiratory distress syndrome (ARDS), some survivors in the acute phase are unable to wean from extracorporeal membrane oxygenation (ECMO) or mechanical ventilation. To date, little is known regarding whether lung transplantation confers a survival benefit for irreversible ARDS. Methods This retrospective study was conducted using the United Network for Organ Sharing database (May 2005–December 2018). Patients with restrictive lung disease were divided into two groups: patients with and without ARDS. Propensity score matching identified recipients without ARDS for the control group. Results A total of 63 patients with ARDS were waitlisted for lung transplantation, while 39 received a lung transplant after a median waitlist duration of 8 days. Seventy‐eight patients were matched as controls. In the ARDS group, the median age was 30 years, and the median lung allocation score was 88.4. Among the 39 recipients, 30 (76.9%) received ECMO support prior to transplantation. Lung transplantation for ARDS and restrictive lung disease showed similar 90‐day (87.2% vs. 88.5%, p = .80), 1‐year (82.1% vs. 85.9%, p = .52), and 3‐year (69.2% vs. 65.4%, p = .94) survival rates. Conclusions Lung transplantation provides acceptable outcomes in selected patients with irreversible ARDS.

Lung Transplantation for Acute Respiratory Distress Syndrome

“…All three series report prolonged mechanical ventilation after lung transplantation with a median length of mechanical ventilation (LMV) of 11-33 days 40 , 43 and a prolonged hospital stay with a median of 33-56 days ( Table 1 ). 40 , 42 , 43 However, these results are comparable to other complex patient groups, especially those with acute on chronic lung disease who require ECLS bridging to lung transplant. 44 , 45 , 46 , 47 , 48 Long-term survival following lung transplantation for ARDS was also lower compared to contemporary benchmarks.…”

“…This represents the largest case series to date, including 65 patients listed for lung transplantation between 2005 and 2018. 42 Sixty-one percent (n=39) reached transplantation. The remaining patients were delisted either due to further deterioration or because their native lungs ultimately recovered.…”

Lung transplantation for COVID-19-associated acute respiratory distress syndrome: The first French patient

“…However, only a few cases of LT for ARDS have already been reported ( 13 ) ( 14 ) ( 15 ) ( 16 ) ( 17 ). Data, from the UNOS registry was recently published and suggested interesting results with a 63% survival rate three years after LT ( 18 ). The current COVID-19 pandemic is responsible for a great increase in patients with ARDS and the mortality of the sickest patients needing ECLS is around 40 % at 90 days ( 19 ) ( 20 ).…”

Lung transplantation for coronavirus disease 2019 (COVID-19): The who, what, where, when, and why

“…Of the remaining 24 patients who were waitlisted but did not receive a lung transplant, 16.7% were removed due to clinical improvement. 10 Optimizing the potential for native lung recovery and avoiding a lung transplant is likely best practice, considering the limited supply of acceptable donor lungs in comparison with the number of patients currently awaiting a lung transplant as well as the less-than-desirable longterm survival expectations for LTx recipients. Thus, it is our best practice opinion that LTx is considered only when sufficient time has elapsed to exclude meaningful lung recovery.…”