Short-Term Outcomes of Lung Transplantation for COVID-19 ARDS: A Single Center Experience

PURPOSE: The outcomes of lung transplant (LTx) for COVID-19 related lung disease are continuing to be examined. This study describes our experience in the first 7 cases. METHODS: This study included all patients received double LTx (DLTx) for COVID-19 acute respiratory distress syndrome (ARDS) between November 2020 and October 2021. Patient pre-LTx and perioperative characteristics as well as post-LTx outcomes are presented. RESULTS: Seven patients underwent DLTx for COVID-19 ARDS. All required mechanical ventilation (MV) pre-LTx. Six patients were male (85%), 5 Hispanic (71%), with a median age of 48 (IQR 40-53) and median body mass index of 23.6 (IQR 21.7-25.6). Six patients (85%) were on veno-venous extracorporeal membrane oxygenation (VV-ECMO) pre-LTx (one conversion from VV to veno-arterial (VA)). Median duration of MV and ECMO pre-LTx was 140 days (IQR 82-165) and 71.5 days (IQR 58-149), respectively. Two patients developed acute kidney injury pre-LTx requiring continuous renal replacement therapy (CRRT). Median time from listing to transplant was 17 days (IQR 10-24). ECMO was discontinued in all but 1 patient post-LTx. Median length of stay in the hospital post-LTx was 30 days (IQR 15-57). All were discharged from the hospital (43% to rehabilitation facility). Two patients on pre-LTx CRRT remained hemodialysis dependent and had multi-drug resistant (MDR) bacterial infections post-LTx. One readmission occurred for presumed rejection, aspiration and infection with MDR Klebsiella now requiring oxygen. All surgical pathology showed diffuse interstitial fibrosis consistent with the fibrotic sequelae of alveolar damage due to COVID-19. At 3-month follow-up, 6 patients (85%) did not need supplemental oxygen and had good pulmonary function. CONCLUSION: Lung transplantation for COVID-ARDS is feasible. However, pre-transplant multi-system involvement may be associated with a protracted post-LTx stay and MDR infection. Further studies are needed to assess the long-term outcomes in this cohort.