Lung Transplantation for COVID Acute Respiratory Distress Syndrome: A Pediatric and Adult Case Series

ABSTRACT

Purpose: Lung transplantation (LTx) has been shown to be a viable treatment for irreversible lung disease caused by COVID-19. Given the limited data on the subject, our purpose was to examine the process and outcomes of LTx for COVID Acute Respiratory Distress Syndrome (ARDS) in a retrospective single center cohort study which includes one pediatric patient. Method(s) This case series is a retrospective review of our patients diagnosed with COVID ARDS who underwent LTx for that diagnosis. All LTx in this cohort occurred between September 9, 2020 and August 26, 2021. We report on candidate selection, pre-LTx patient care, intra-operative procedure, and post-transplant recovery. Result(s) A total of ten patients that underwent LTx for COVID ARDS were identified. The average age of the cohort was 44.9 years (range of 16-60 years) and the mean Lung Allocation Score (LAS) 85.4 +/- 9.65. LTx occurred on average 96.5 +/- 32.9 days following onset of COVID symptoms. Seven patients (70%) in the cohort were bridged to LTx on extracorporeal membrane oxygenation (ECMO) for an average of 72.1 +/- 25.9 days. Six patients (60%) required mechanical ventilation prior to LTx. Intra-operatively, seven patients received life support via ECMO, 2 via off-pump, and 1 via cardio-pulmonary bypass (CPB). Seven patients required intraoperative packed red blood cells (mean 5.4 +/- 2.5). Following transplant, 60% of patients received ECMO for a mean duration of 2.0 +/- 0.9 days;90% of the cohort received ventilatory support. At 72 hours following surgery, cohort graft viability surpassed in center averages for non COVID LTx recipients;50% of patients had no primary graft dysfunction (PGD) (grade 0) and 50% had PDG grade 1. Discharges occurred 29.0 +/- 11.7 days following LTx and no episodes of acute rejection were noted in this time frame. As of publication there is 100% patient and allograft survival. Conclusion(s) While substantial center resources and expertise are required, LTx for COVID ARDS can be safely performed with a high rate of success. Careful candidate selection, donor selection, and institutional support were all critical elements that contributed to the 100% success rate observed in this cohort, which includes the youngest reported patient to undergo LTx for COVID ARDS.