Prevalence and Characteristics of Covid-19-Associated Pulmonary Diagnoses in Lung Transplant Patients in the United States

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).

OPTN/SRTR 2020 Annual Data Report: Lung.

For the first time in a decade, both the number of candidates added to the waiting list and the number of lung transplants performed decreased from the year prior; the number of lung donors also declined. This slowing of transplant activities in 2020 was associated with a modest increase in waitlist mortality. The year 2020 was notable for the global outbreak of the COVID-19 pandemic, which undoubtedly influenced all trends noted in lung transplantation. Time to transplant continued to decrease, with a median time to transplant of 1.4 months across all waitlist candidates. Posttransplant survival remained stable, with 89.4% of transplant recipients surviving to 1 year, 74.8% to 3 years, and 61.2% to 5 years.

The initial impact of COVID-19 on reported graft failure rates and potential confounding of SRTR PSRS

Purpose: COVID-19 could bias the Scientific Registry of Transplant Recipients (SRTR) program-specific reports (PSRs), especially if its impact varied geographically. Methods: Recipients who received transplants from January 1, 2000 to April 30, 2020 and had graft function on March 13, 2019 were included. To assess the risk of confounding, we estimated the overall and donation service area (DSA)-specific differences in graft failure rates from March 13, 2019 to March 12, 2020 compared with rates from March 13 to April 30, 2020, after adjusting for recipient and donor characteristics. Results: Kidney, liver, and heart recipients had higher adjusted graft failure rates after COVID-19 than before (Figure 1). Graft failure rates for kidney and liver recipients who received a transplant in the New York City DSA were significantly higher after COVID-19 than before (Figures 2 and 3, respectively). Lung and heart transplant recipients had significantly less variability across DSAs. Conclusions: Taken together, these results suggest potential confounding of SRTR PSRs, especially for kidney and liver transplant programs in the New York City DSA. Thus, SRTR is censoring transplant follow-up after March 12, 2020 for PSRs released in January 2021 to minimize potential bias. However, further studies are required to identity long-term solutions for minimizing potential confounding of SRTR PSRs by COVID-19.