(690) Lung Transplant for Severe Covid-19-Related Acute Lung Injury: Promise or Over-Enthusiasm? Clinical Characteristics and Outcomes of Patients Bridged on Extracorporeal Membrane Oxygenation

PURPOSE: COVID-19 can cause severe respiratory failure, for which lung transplant (LTx) is a potentially lifesaving treatment. However, uncertainty still surrounds patient selection and timing of referral. Our study objective was to identify factors associated with recovery (weaning from ECMO and intensive care unit discharge) versus death of patients with severe COVID-19-related acute lung injury on Extracorporeal Membrane Oxygenation (ECMO) listed for lung transplantation. METHODS: Retrospective review of all consecutive cases referred to our center and listed for LTx between July 1, 2020, to June 30, 2022. Patients were considered eligible for LTx in case they had shown no longitudinal evidence of lung recovery after at least 4 to 6 weeks had elapsed from the onset of severe COVID-19-related lung injury. Factors associated with recovery versus death were assessed. RESULTS: Twenty patients were included in the study: 4 underwent a LTx, 9 recovered, and 7 died. The median time from hospital admission to listing was 85.5 days [IQR 65.75, 140.25] and the median time on the transplant wait list was 25.5 days. Patients who recovered were younger (44 years [IQR 41,55] vs. 61 [IQR 49.5,65.5], P value=0.016). Time on ECMO was significantly shorter for those who recovered (59 days [IQR 53, 93] vs. 99 [IQR 83.5, 137.5], P value=0.044). CONCLUSION: Although the question regarding which patients are in a need for LTx remains unanswered, the present study informs on timing of consideration for LTx for patients with severe COVID-19-related lung injury. Based on our findings, we suggest delaying LTx consideration for 8-10 weeks from initiation of ECMO. Further, our experience demonstrates that current advances in management on ECMO allows prolonged support without significant complications in selected patients.