Small Study Shows 100% Success in Lung Transplants for COVID-19–Associated ARDS

Among 30 patients with COVID-19-associated acute respiratory distress syndrome (ARDS) who underwent a lung transplant, survival was 100%, according to a study published in JAMA.

The study was performed to gain more information about the long-term outcomes of patients who have lung transplants after contracting COVID-19-associated ARDS. The researchers also included the outcomes of patients without COVID-19 who received a lung transplant for chronic end-stage lung disease, including idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), cystic fibrosis, and pulmonary hypertension. Before the pandemic, patients with these diseases were rarely considered for lung transplants, according to the authors.

In 2021, a global group of transplant centers proposed guidelines for lung transplants COVID-19-associated ARDS, but they have been inconsistently applied due in part to a lack of clarity about long-term outcomes for these patients.



The single-center, retrospective case series included 102 consecutive patients who underwent a lung transplant between January 21, 2020, and September 30, 2021, at Northwestern University Medical Center in Chicago, Illinois. Thirty of these patients were categorized as having COVID-19-associated ARDS, while the other 72 had chronic end-stage lung disease, but did not have COVID-19 infection.

For the patients with COVID-19-associated ARDS, the median age (interquartile range [IQR]) was 53 (46-59) years, and 62 years (52-69) for those without COVID-19. There were slightly more men than women in each group, and the group without COVID-19 had a notable amount of non-Hispanic White patients (63.9%).

The median preoperative Karnofsky Performance Status score was 30 in the COVID-19 group and 50 in the non-COVID-19 group. Additionally, the median lung allocation scores were 85.8 and 46.7, and the median lung transplant wait time was 11.5 days (IQR, 5.2-26.0) and 15 days (IQR, 6.0-60.0), respectively.

Of the group with COVID-19-associated ARDS, 17 patients were being treated with preoperative venovenous extracorporeal membrane oxygenation (ECMO) and 4 were receiving invasive mechanical ventilation immediately before the lung transplant. In the other group, only 1 was being treated with ECMO and 2 were receiving invasive mechanical ventilation before the transplant.



During their ICU stay prior to lung transplant, 29 patients with COVID-19-associated ARDS received invasive mechanical ventilation and 1 received noninvasive mechanical ventilation. The authors noted that none of these patients were vaccinated against COVID-19 at the time, and only 1 patient in the non-COVID-19 group was vaccinated at the time.

The proportion of patients reporting history of hypertension and diabetes was comparable in each group, although more patients in the non-COVID-19 group reported history of smoking and chronic kidney disease. Additionally, interstitial lung disease and COPD were the most common causes of chronic end-stage lung disease for the non-COVID-19 group.


As of the last date of follow-up on November 15, 2021, survival was 100% in the 30 patients who had COVID-19-associated ARDS, and 83% for those without COVID-19 infection.

The authors noted multiple study limitations, including small sample size, singular location, and a stringent selection of lung transplant recipients in patients with COVID-19-associated ARDS.

They also addressed a concern that has been raised in relation to the supply of donor lungs.

“While offering double lung transplants to patients with COVID-19-associated ARDS has the potential to increase demand-supply discordance, this effect has not been documented in the medical literature to date,” the authors said. “During this study, no increase in waitlist mortality was observed in the non-COVID-19 cohort at our center with the introduction of lung transplant for patients with COVID-19-associated ARDS; however, this needs to be studied in other centers with a different supply of donor lungs.”

Reference

Kurihara C, Manerikar, Querrey M, et al. Clinical characteristics and outcomes of patients with COVID-19-associated acute respiratory distress syndrome who underwent lung transplant. JAMA. 2022;327(7):652-661.doi:10.1001/jama.2022.0204