“Impressive” survival of COVID patients undergoing lung transplantation

According to one study, hundreds of patients in the United States have undergone lung transplants with COVID-19, and preliminary mortality is comparable to transplants for other reasons.

7% of lung transplants from the United Network for Organ Sharing (UNOS) data (214 out of 3,039 cases from August 1, 2020 to September 30, 2021) were performed due to respiratory failure due to COVID-19. I did.

Joanna Chikwe, MD, MD, Cedars-Sinai Medical Center in Los Angeles, said it was actually surprising that this percentage was not high. New England Journal of Medicine..

“We were all worried that this would represent a much higher percentage of lung transplant patients,” she said. Today’s MedPage.. “And hopefully this will impose unreasonable demands on the pool of lung transplant donors and deprive other patients of life-saving therapy, as this seems to have experienced the worst COVID.”

Median follow-up was only 1.9 months, but 30-day mortality was 2.2% (4 deaths) and 3-month survival was 95.6% (95% CI 90.1-98.1), which Chikwe said. I call it “really impressive”. .. “

In the United States, the overall 3-month survival rate after lung transplantation was 93%. data.. According to the report, the one-year survival rate of lung transplant patients reached 88.8% before the pandemic. 2019 UNOS data..

The similarity in survival rates was “the most amazing thing in this study,” Chikwe said. “These patients were so ill that we completely expected that mortality after a lung transplant would be almost exorbitant.”

The majority of transplants in COVID-19 patients followed mechanical ventilation (53.0%) and extracorporeal membrane oxygenation (64.5%), but the proportion requiring such support is pre-pandemic UNOS data. Then it was one digit.

Almost all transplants (92.1%) were bilateral lung transplants, including two cardiopulmonary transplants and five lung kidney transplants. According to UNOS data in 2019, 75.5% of lung transplants were bilateral.

Transplantation in the United States stopped early in the pandemic, before more than a rebound.The center reports good results as follows: Donor lungs from offspring with a history of COVID-19, The death of a woman from last year COVID-19 contracted from the lungs She was also concerned about testing the protocol, even though she received it from a donor who was not known to be infected at the time.

“Given the lack of lungs and the demand for ICU resources via COVID, was the use of this resource justified? These patients worked so well that the clear message is clear. I think it’s an absolute yes, “says Chikwe.

Her group investigated UNOS registry data after the first wave of the pandemic, and of the 64 centers performing adult lung transplants, the median for COVID-19-related respiratory failure was 2.5. However, the range was up to 25. ..

More was done for acute respiratory distress syndrome (140 cases, 4.6% of all transplants) than for pulmonary fibrosis (74 cases, 2.4%). However, the latter group recovered well enough to get out of the ventilator, but patients with irreversible and severe pulmonary fibrous changes due to severe infection and thromboembolic disease required more selective transplantation. It may grow over time as it may progress to the stage of Chikwe pointed out.

COVID patients who received a transplant looked in many ways different from the typical lung transplant population.

In severe and fatal cases where males predominate, of course, COVID-19 lung transplants occur imbalanced in males, with 20.8% of recipients female, but in 2019. The overall UNOS data for lung transplants was 40%. ..

They were also young (median 52 years) and more likely to be Hispanic (37% vs. about 10% normal).

The limits of the study are incomplete data on how long the lung recipient was ventilated or circulatory assisted prior to transplantation, whether they had been previously vaccinated with COVID, and what the COVID test showed at the time of transplantation. Was included.

More importantly, “short-term follow-up eliminates firm conclusions about the long-term usefulness of lung transplants in this context,” Chikuwe’s group warned.