Early outcomes after lung transplantation for severe COVID-19: a series of the first consecutive cases from four countries

January 27, 2021

Ankit Bharat, Tiago N Machuca, Melissa Querrey, Chitaru Kurihara, Rafael Garza-Castillon Jr, Samuel Kim, MD, Adwaiy Manerikar, Andres Pelaez, Mauricio Pipkin, Abbas Shahmohammadi, Mindaugas Rackauskas, Suresh Rao KG, K R Balakrishnan, Apar Jindal, Lara Schaheen, Samad Hashimi, Bhuvin Buddhdev, Ashwini Arjuna, Lorenzo Rosso, Alessandro Palleschi, Christian Lang, Peter Jaksch, Prof G R Scott Budinger, Prof Mario Nosotti, Prof Konrad Hoetzenecker

Lancet Respiratory Medicine

Lung transplants have been performed after acute respiratory distress syndrome (ARDS) associated with COVID-19. Twelve cases were considered in this series; collected information related to patient demographics and pre-COVID-19 characteristics, including comorbidities, pre-transplant profile, perioperative challenges, pathologic evaluation of explanted lungs, and post-transplant outcomes. All patients had complications from the SARS-CoV-2 infection, for which they were in the ICU. Prolonged ECMO causes platelet dysfunction in patients as they connect to transplantation. Lung transplantation for COVID-19-related ARDS is associated with a significant increase in bleeding. Pleural adhesions and fragile tissue quality increase intraoperative bleeding, potentially increasing postoperative risk. Furthermore, patients in this cohort had prolonged ventilation and a difficult recovery as expected after transplantation. However, the risk of serious complications and functional weakening after ARDS is associated with increasing age and the presence of comorbidities at baseline rather than with the severity of the disease. Therefore, given that the patients in this study were in normal health before the onset of ARDS associated with COVID-19, they hypothesized that frailty was reversible after lung transplantation. Therefore, the recommendations they suggest are that the consideration of lung transplantation be limited to patients requiring mechanical ventilation or ECMO despite several weeks of optimal medical care, with advanced disease, radiological signs of irreversibility and a high risk of developing complications. life threatening. Additionally, patients who develop severe COVID-19 chronic pulmonary fibrosis could be considered for a lung transplant.

Bharat A, Machuca T, Querrey M. Early outcomes after lung transplantation for severe COVID-19: a series of the first consecutive cases from four countries. Lancet Respiratory Medicine 2021. DOI: https://doi.org/10.1016/S2213-2600(21)00077-1

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