Favorable Survival Outcomes in COVID-19 Lung Transplant Recipients

Recent Chronicle of Thoracic Surgery journal research Survival of lung transplant (LT) recipients who experience respiratory failure after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is significantly different from survival of patients who underwent LT for other reasons reported that there were no pulmonary etiology.

study: Concordant survival analysis of lung transplant recipients with Covid-19-related respiratory failure. Image credit: mi_viri / Shutterstock.com

Background

Coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2 infection, has infected more than 624 million people and killed more than 6.56 million. COVID-19 primarily affects lung tissue. However, it can also damage various other organs.

COVID-19 causes two serious forms of respiratory failure: pulmonary fibrosis and acute respiratory distress syndrome (ARDS). Both conditions may require extracorporeal membrane oxygenation (ECMO), prolonged mechanical ventilation, supplemental oxygen, and physical desynchronization.

LT is often recommended for patients with end-stage respiratory failure. More recently, some clinicians have also recommended her LT for patients experiencing severe her COVID-19 who have not responded to other treatments.

Compared with respiratory failure due to other causes, patients with COVID-19-related respiratory failure often have worse initial symptoms before LT. Nevertheless, previous studies have reported similar survival rates for both types of her LT recipients.

Survey results

Between 2006 and 2021 in the United States, 37,333 patients were listed for LT after lung injury from other etiologies, whereas 334 patients were listed for LT for respiratory failure after SARS-CoV-2 infection. was recommended.

Within the COVID-19 cohort, patients were more likely to have a higher Lung Assignment Score (LAS) with a mean of 78.3 compared to a mean of 43.1 in other groups. Similarly, 51.2% of the COVID-19 group required his ECMO compared to 1.8% in the non-COVID-19 group, but 36.5% and 3.0% required ventilation, respectively.

Six months after the initial diagnosis, LT was performed in 87.9% and 63.3% of COVID-19 patients, as well as those with other lung-related impairments, respectively.

COVID-19 patients were less likely to die while on the waiting list for new lungs. The likelihood of receiving LT was comparable between both patient groups. Nonetheless, the COVID-19 LT recipient waited for her transplant for a median of 14 days compared to his 48 days for other his LT recipients.

Recipients of COVID-19 LT were more likely to have reduced functional status, be admitted to an intensive care unit (ICU), be placed on ECMO, and require ventilation. Her LAS in these patients was significantly higher before LT.

Overall length of hospital stay for COVID-19 LT recipients was significantly longer than for other LT recipients. Seventy-two hours after his procedure, the COVID-19 patient, likely on her ECMO, remained intubated and required dialysis. Despite the poor overall functional status of these patients, both COVID-19 and other her LT recipients showed similar acute rejection, 30-day mortality, and 90-day mortality .

It should be noted that COVID-19 LT recipients had worse functional outcomes after transplantation. Researchers hypothesize that this may be due to acute illness in these patients prior to transplantation.

Conclusion

COVID-19 patients who experience respiratory failure often deteriorate rapidly, leading many clinicians to investigate the potential benefits of LT for these patients. In the current study, researchers similarly found that COVID-19 patients with respiratory failure were critically ill when they were first placed on the waiting list for LT.

In fact, many of these patients were in ECMO, mechanical ventilation, or ICU when they were first listed to receive LT. As her LAS in a COVID-19 respiratory failure patient worsened, her waiting list time decreased significantly, as did her chances of dying while waiting for her lungs.

Despite the worsening acute condition of these patients, both COVID-19 LT recipients and LT recipients with other etiologies showed similar 6-month survival rates. Therefore, the favorable survival outcome of a COVID-19 LT recipient may support changes to current consensus guidelines for her LT in this patient population.

Various factors that may contribute to the high survival rate of COVID-19 LT recipients include careful selection before being placed on the waiting list, overall young age, nature of COVID-19, and Improvements to recent methods may be included. Her COVID-19 patient in critical condition is being treated in her ICU.

Overall, a history of COVID-19-related lung failure did not increase the risk of death in LT recipients. Nonetheless, due to the high incidence of postoperative complications in these patients, further studies are needed to determine the speed at which COVID-19 LT recipients return to baseline levels after transplantation.