Radiographic and Histopathologic Lessons from COVID-19 Explants

PURPOSE: COVID-19 acute respiratory distress syndrome (ARDS) can result in irreversible lung damage. Lung transplant is a viable option for such select patients. Our aim is to describe the radiologic features prior to lung transplant and post transplant explant pathology, in such patients. METHODS: A single center retrospective chart review was performed of adults who underwent lung transplant for COVID-19 ARDS from 7/1/2020 until 7/31/2021. Demographic data, imaging reports at the time of listing and explant pathology were collected. RESULTS: 25 patients were included and none of them had pre-existing lung disease. Chest CT reports obtained at the time of transplant listing and post transplant lung explant reports were reviewed. Most common radiographic and explant features were traction bronchiectasis and NSIP pattern interstitial fibrosis, respectively. CONCLUSION: To our knowledge, this is the largest descriptive report on COVID 19 explants. Though NSIP pattern is the most common finding on explants, only 48% of patients had fibrosis on CT scan prior to listing. Hence, other findings reflective of end stage lung disease such as traction bronchiectasis, GGO's should be considered along with respiratory mechanics while assessing the need for lung transplant for COVID-19 ARDS.