ABSTRACT
Purpose: Lung transplant may be a viable treatment option for select patients with non-recoverable COVID-19-associated acute respiratory distress syndrome (ARDS) and COVID-19-associated pulmonary fibrosis. This study aims to characterize the utilization and outcomes of lung transplant among patients with COVID-19- associated ARDS and pulmonary fibrosis. Method(s): We analyzed the Organ Procurement Transplant Network database to characterize the prevalence and characteristics of patients with COVID-19-associated ARDS and pulmonary fibrosis who were added to the waiting list and/or received a lung transplant between March 13, 2020 and July 31, 2021. Result(s): We found that 207 lung candidate registrations were added to the waiting list and 182 lung transplants were conducted for patients with COVID-19-associated ARDS or pulmonary fibrosis. The majority of lung candidates and lung transplant recipients with COVID-19-associated diagnoses were male, had private insurance, were disproportionately Hispanic and had a higher lung allocation scores (LAS) compared to patients with non-COVID-19 diagnoses. There was no significant difference in 30-day post-transplant survival among recipients with COVID-19- associated diagnoses compared to non-COVID-19 diagnoses. Conclusion(s): Future research on post-transplant outcomes among lung transplant recipients with COVID-19-associated diagnoses is warranted. Further study of outcomes may assist in refining the appropriate LAS waitlist mortality and posttransplant survival scoring for these patients. (Figure Presented).
ABSTRACT
Purpose The novel coronavirus (COVID-19) pandemic presented unique challenges to lung transplant (LTx) programs. On the donor side, infection concerns resulted in a dramatic reduction in donor lung offers and raised the specter of viral transmission to procurement team members. On the recipient side, the need for pre-transplant COVID-19 testing and COVID free patient care units presented unprecedented logistical challenges. New indications for ex vivo lung perfusion (EVLP) also emerged, including logistics (e.g. providing adequate time for recipient COVID testing), and donor lung evaluation following 3rd party procurement. In this study, we defined the novel roles of EVLP that our LTx program developed during the COVI-19 pandemic. Methods Retrospective analysis of adult LTx procedures performed at our institute from March 17th (when COVID restrictions began at our institute) through May 31st 2020, compared to LTx performed during the same period in 2019. Results During the study period, 17 LTx were performed. Eight of 17 were performed after EVLP evaluation, and 6 with EVLP back-up. Notably, the number of LTx after EVLP doubled vs. the same period in 2019, and the number of LTx cases with EVLP backup tripled (Figure 1A). Indications for EVLP in 4 LTx cases and 4 cases with EVLP backup were unique to pandemic conditions (Figure 1B). To date, no patients transplanted during this period, or team members tested positive for COVID-19, or are suspected of COVID infection post-LTx. 30-day survival was 100%, and incidence of primary graft dysfunction grades 0, 1, 2, and 3 at 72 hours post-transplant were 39%, 52%, 4%, and 4%, respectively. Median ventilation duration was 1 day. Conclusion Maintaining LTx activity with EVLP was feasible in the early phases of the COVID-19 pandemic. EVLP enabled our team to solve challenges with donor evaluation and logistics. By enabling donor assessment after local procurement, EVLP also increased the procurement team's safety. In the future, these newer EVLP indications may be applicable beyond the COVID-19 pandemic.