Is Lung Transplant a Viable Option for Patients With Severe COVID-19?

According to a recent study designed to evaluate the efficacy and feasibility of lung transplantation for respiratory failure from COVID-19, transplantation can produce acceptable results if it is performed in a timely manner and patients undergo the appropriate qualification process. The retrospective study was published in Transplantation Proceedings.

Researchers from the Medical University of Silesia in Katowice, Poland, analyzed the medical records of 119 patients who were critically ill with respiratory failure from COVID-19. All were hospitalized at a single center and had been referred for lung transplantation between July 2020 and June 2021. The mean patient age was 52.02±10.17 years, and 74.14% of patients were male.

“Available data show extensive evidence of injury and fibrosis that resembled end-stage pulmonary fibrosis,” the authors wrote of these patients. Eligible patients were confirmed to be free from SARS-COV-2 infection by reverse transcription polymerase chain reaction testing and had been required to review all other available treatment options prior to deciding upon transplantation.

Findings from the review showed that most patients had end-stage respiratory failure with extracorporeal membrane oxygenation (55.36 %) and invasive mechanical ventilation (32.14%). Of the referred patients, 21.84% were ineligible for transplantation because of contraindications to the procedure or life-long immunosuppressant therapy. Typical contraindications included severe kidney failure, a compromised neurological state, and cardiovascular complications.

In all, 75.8% of eligible patients expired without transplantation, primarily due to long wait times for donated organs. Of the patients undergoing transplantation, 9 received double-lung transplants. A total of 33% of patients expired during transplant surgery. Full respiratory competence was restored in 4 patients, who remain independent approximately 1 year after the procedure.

“Patients with severe irreversible respiratory failure after COVID-19 present significantly high mortality without lung transplantation,” the authors noted. “This procedure may present satisfactory results, but must be performed timely due to critical condition and scarcity of lung donors, only aggravated around the time of peak
infection waves,” they advised.

The arrival of COVID-19 as a new source of acute respiratory distress has posed an ethical dilemma for transplantation specialists who must weigh the shortage of donors against the rising number of potential transplant recipients. The fact that most patients referred for lung transplantation in Poland are not vaccinated complicates the problem further. “Lung transplant programs should have the explicit goal of maximizing long-term survival in order to provide net survival gains for society as a whole,” the authors stated. “COVID-19 survivors should be evaluated for transplant only if they have demonstrated lack of clinical improvement, persistent parenchymal infiltrates. as well as severely reduced lung compliance after prolonged support,” they explained.

Reference

Urlik M, Stącel T, Latos M, et al. Lung transplantation as a treatment for patients with end-stage respiratory failure due to coronavirus disease of 2019 (COVID-19). Transplantation Proceedings. Published online March17, 2022. doi.org/10.1016/j.transproceed.2022.03.017

This article originally appeared on Pulmonology Advisor