Favorable Survival Rates Are Possible After Lung Transplantation for COVID-19

Critical cases of COVID-19 can progress to end-stage pulmonary fibrosis, and 7% of lung transplants in the U.S. have recently been performed for this indication (N Engl J Med 2022 Jan 26; [e-pub]). Investigators now report on 30 patients transplanted as a result of COVID-19; clinical characteristics and outcomes were compared with those in 72 contemporaneous patients receiving lung transplants for other indications. To be considered for lung transplantation, patients with acute respiratory distress syndrome (ARDS) caused by COVID-19 were ≥4–6 weeks into the episode with no evidence of improving lung function and two negative lower tract SARS-CoV-2 specimens.

At transplant, patients with COVID-19 were more likely than those without COVID-19 to be on ECMO (56.7% vs. 1.4%) or invasive mechanical ventilation (13.3% vs. 2.8%) and were younger (median age, 53 vs. 62). Postoperatively, patients with COVID-19 had higher rates of early primary graft dysfunction (70.0% vs. 20.8%) and longer stays in the ICU (18 vs. 9 days) and in the hospital (28 vs. 6 days). They were also more likely to require permanent hemodialysis (13.3% vs. 5.5%). All recipients recovering from COVID-19 were alive at last follow-up (median, 351 days).