Impact of COVID-19 on Lung Transplantation in Australia

PURPOSE: The impact of COVID 19 on lung donors and lung transplant recipients in Australia has not been studied. This study followed the impact of COVID 19 in the initial Australian COVID 19 surge. METHODS: This was a retrospective cohort study which examined data from the centre's local CPRS transplant database, Australia and New Zealand Organ Donation Registry and hospital medical records from 01(st) Jan 2017 to 31(st) August 2020. Organ donation patterns, cause of donor deaths, recipient characteristics and transplant surgery volumes were monitored. RESULTS: Over the 8 months, from 1(st) of January to 31(st) August, there were 26 lung transplants in 2020 compared to 35 in the same period in 2019 at the centre. Suicide and overdose became 2.65 times more likely as causes of donor death at the centre and 1.60 times more likely nationally. Heart attack and stroke became less likely causes of donor death. Lung transplant recipients were more likely to have a diagnosis of pulmonary fibrosis, but had on average improved measures of pre-surgical frailty and improved operative outcomes. The exception to this was ICU time and ventilatory time, which increased on average. MOCA scores improved on average, suggestive of better mental acuity. Indicators of mental health were worse in the 2020 cohort, based on the average dmi10 depression screening score. CONCLUSION: There was a 69.23% decline in volume of organ transplantation as of August 2020. With the initial surge of cases the transplant volumes decreased dramatically, however with “lockdown” and control of “COVID cases” the lung transplant rates increased. The Victorian outbreak from August further diminished rates of transplant due to travel restrictions, however the NSW based unit managed to maintain lung transplant levels with local donors and minor interstate referrals. An increase in physical robustness corresponds to increased referral and uptake of “prehabilitation” by waitlisted patients.