Comparing Outcomes of COVID-19 vs NonCOVID-19 Lung Transplant Recipients on ECMO as a Bridge to Transplant

PURPOSE: Despite advances in treatments for COVID-19, a subset of patients develop end stage lung disease, necessitating lung transplantation. However, COVID-19 ARDS often requires prolonged intubation with sedation and paralytics, resulting in profound deconditioning. As such, extracorporeal membranous oxygenation (ECMO) is a useful bridge to transplant to allow for a wakeful state and facilitate rehab. This study compares outcomes among patients with COVID-19 and nonCOVID-19 lung disease placed on ECMO as a bridge to transplant. METHODS: All patients on veno-venous ECMO prior to lung transplantation at a single center from Jan 2020 - Oct 2021 were identified. Patient characteristics and post-transplant outcomes were abstracted for comparison. RESULTS: A total of 7 patients were identified in the COVID-19 (C) cohort and 11 in the nonCOVID-19 (NC) cohort. Age and LAS at transplant were similar (Table 1). As expected, total duration on ECMO was longer for C cohort patients (85.4 vs 14.5 days). Patients in the C cohort had longer ischemia times and more returns to the OR within 72 hours of transplant (71% vs 45%). Rates of hemodialysis within 30 days of transplant were lower in the C cohort (14% vs 18%). Further, C cohort patients had higher rates of detectable donor specific antibodies by IgG (71% vs 55%), though all were negative by C1q and compatible cross matches. While total and ICU lengths of stay were longer in the C cohort, this group had a shorter post-transplant hospital length of stay. Median time post-transplant was 212 days for the C cohort and 154 days for the NC cohort; survival was 100% for both groups at follow up. CONCLUSION: For patients with COVID-19 ARDS, ECMO is a useful bridge to transplant to mitigate complications associated with prolonged mechanical ventilation. These preliminary data suggest prolonged periods of ECMO pre-transplant do not result in significant adverse events post-transplant. Additional analyses of graft function and survival at 6 and 12 months are ongoing.