Lung Transplantation for Post COVID19 End Stage Lung Failure: A Case Series from 3 Latin American Countries

PURPOSE: Lung transplantation has currently become a therapeutic option in severe cases of COVID-19, which present extensive and irreversible lung damage. We aim to assess demographic characteristics, and evolution of pre-transplant SARSCoV2 infection, complications, and post-transplant survival. METHODS: Retrospective case series from 4 Lung Transplant Centers of 3 Latin American countries: Chile, Brazil, and Mexico, including patients that underwent lung transplantation for post-COVID19 end stage lung failure. RESULTS: From January 2020 to September 2021, 13 bilateral lung transplants due to severe cases of post-COVID19 lung failure were performed. 69.2% in men, with an average age of 44 years (range 25 to 61 years). From symptoms onset, average intubation time was 12.9 days, and connection to ECMO was, on average, at 12.3 days, (range 2 to 28 days). Transplants were on average at 85.5 days from the connection to ECMO (range 52 to 167). Mean was BMI was 28.3 kg/m2 (range 24.4 to 35.5). One patient had previous comorbidity (arterial hypertension). Before transplantation, 100% were connected to ECMO, none of them were sedated, 11 achieved standing, 3 of which kept walking, and 53.8% maintained spontaneous ventilation. Transplant surgical approach used was Clamshell in 11 patients and median sternotomy 2. Intra-operative cannulation was performed in 100%, being veno-venous in 2 and veno-arterial in 10 of them. 61.5% of the cases (8 patients) remained on ECMO after surgery, for an average of 6.6 days (0 to 22).61.5% of the patients had complications, being bleeding, vascular stenosis, infections, and kidney failure are described. Overall survival was 53.8% (7 patients) with a median follow-up of 64 days. The 30-day survival rate was 75%. Average time to discharge was 44.6 days after transplantation, with total average time of hospitalization of 142 days (74 to 257). CONCLUSION: Transplantation is considered as part of the therapeutic arsenal in those patients who have confirmed irreversibility of lung damage, despite medical support. However, the delay in transplantation and the consequent connection to prolonged ECMO is observed consistently in our countries, probably due to a low rate of organ donation. This exhibits the need for a better assessment on when to perform the transplant, considering the low donor rate of lung transplant programs in Latin American countries.