Lung transplant ‘may be an acceptable treatment’ for some with COVID-19 respiratory failure

Of more than 3,000 lung transplants performed in the U.S. from August 2020 to Sept. 30, 2021, 7% were performed to treat severe, irreversible lung damage caused by COVID-19, researchers reported in The New England Journal of Medicine.

Further, more than half of these patients required ventilation or extracorporeal membrane oxygenation before lung transplant.

“Because the 3-month survival among these patients approached that among patients who underwent lung transplantation for reasons other than COVID-19, we believe that lung transplantation may be an acceptable treatment for selected patients with irreversible respiratory failure due to COVID-19,” Amy Roach, MD, general surgery resident and Nagel Research Fellow in the department of cardiac surgery in the Smidt Heart Institute, and colleagues wrote in a correspondence to the editor in NEJM.

The researchers analyzed lung transplantations reported in the United Network for Organ Sharing (UNOS) registry. All transplants were performed from August 2020 through September 2021 in 183 patients (mean age, 52 years; 20.8% women; 36.6% Hispanic).

Among the 7% of lung transplants performed for COVID-19-related respiratory failure, 4.6% were performed for acute respiratory distress syndrome and 2.4% for pulmonary fibrosis. Ninety-two percent were bilateral lung transplantations.

Across U.S. centers performing these lung transplantations for COVID-19 respiratory failure, the median number of transplants per center was 2.5, the researchers reported.

Before transplantation, 53% of patients received mechanical ventilation, 64.5% received ECMO and 4.9% were on dialysis.

Over a median follow-up of 1.9 months, nine postoperative deaths occurred. The causes of death included COVID-19 in one case, respiratory failure in three cases, anoxia in one case, rejection of the transplant in two cases, GI infection in one case and hyperammonemia in one case. The rate of 30-day mortality was 2.2%. The rate of 3-month survival was 95.6%, according to the results.

Complications of lung transplant included stroke in 3.3% of patients, transplant rejection in 6% and new ECMO use in 12%.

“Our experience treating COVID-19 has shown us that extracorporeal membrane oxygenation can be used in carefully selected patients, either as a bridge to lung transplantation or to allow a patient’s own lungs to heal,” Joanna Chikwe, MD, FRCS, founding chair of the department of cardiac surgery in the Smidt Heart Institute at Cedars-Sinai and the Irina and George Schaeffer Distinguished Chair in Cardiac Surgery, said in a press release issued by Cedars-Sinai. “Most of these COVID-19 patients would have been considered too ill to transplant a few years ago, and the surprising finding of our research was how well they did after lung transplantation.”

“Our analysis suggests lung transplants may be a safe option for select patients with the most severe, irreversible lung damage from COVID-19,” Reinaldo Rampolla, MD, medical director of the Lung Transplant Program at Cedars-Sinai, said in the release. “However, our hope is that no one has to go through ECMO or lung transplant because of COVID-19. The best protection we have against severe, aggressive disease is vaccination.”

The researchers noted several limitations of the current research, including incomplete data on duration of ventilatory or circulatory support and COVID-19 tests and immunization before lung transplantation and short-term follow-up.

Reference:

• New data on COVID-19 lung transplants. Published Jan. 26, 2022. Accessed Jan. 26, 2022.