Resident Department of Cardiac Surgery, Smidt Heart Institute, Cedars-Sinai Medical Center Los Angeles, California, United States
Disclosure(s):
Amy Roach, MD: No financial relationships to disclose
Purpose: Lack of comparative data contributes to uncertainty around the appropriateness and outcomes of lung transplant for COVID-19 respiratory failure. Methods: Adult isolated lung transplants in the United Network for Organ Sharing registry between August 1, 2020 and March 30, 2022 (n=3685) were stratified according to whether respiratory failure was attributed to COVID-19. The primary outcome was six-month survival and analyzed with the Kaplan-Meier method. Secondary outcomes were in-hospital complications including stroke, new extracorporeal membrane oxygenation (ECMO), and acute rejection. Cox regression was used to adjust for differences in baseline characteristics including etiology, gender, age, race, diabetes, ventilatory status, ECMO, tracheostomy, dual lung transplant, previous transplant, intensive care requirement, and lung allocation score (LAS). Clustering of patients within each transplant center was accounted for using a robust variance estimator. Results: Among 3685 patients included, 8.0% (n=295) had COVID-19 respiratory failure, including 4.9% (n=180) with COVID-19 acute respiratory distress syndrome, and 3.1% (n=115) with COVID-19 fibrosis, with trends mirroring the pandemic (Figure 1A). The median follow-up was 6.1 months and centers performed a median of 2 transplants for COVID-19 respiratory failure (range 0-26). Compared to patients with non-COVID-19 respiratory failure, patients with COVID-19 respiratory failure were younger (median age 51 (interquartile range (IQR) 42-58) versus 63 (IQR 56-67) years), more frequently male (78.0% (n=230) versus 61.2% (n=2074)), Hispanic (31.2% (n=92) versus 11.3% (n=383)), ventilated (51.9% (n=153) versus 3.8% (n=128)), on ECMO (61.7% (n=182) versus 5.0% (n=171)) with higher median LAS (87.9 (IQR 80-90) versus 40.8 (IQR 35.5-53.3)) (all p< 0.001). There were no significant differences in six-month survival after lung transplants between COVID-19 (93.4% (95% confidence interval (CI) 89.7-96.2%)) and non-COVID-19 patients (91.2% (95% CI 90-92.2%) (p=0.23, Figure 1B), nor in the incidence of stroke (2.4% (n=7) versus 2.8% (n=96)), new ECMO (9.7% (n=11) versus 7.6% (n=245)), or acute rejection (7.8% (n=23) versus 6.1% (n=205)) before hospital discharge (all p>0.05). In Cox regression analysis, COVID-19 was not associated with worse survival at six months (adjusted HR 0.49 (95% CI, 0.25-0.98), p=0.04). Conclusion: Lung transplants for COVID-19 respiratory failure represent 8.0% of lung transplants nationally and are associated with acceptable short-term outcomes in selected patients compared to lung transplants for non-COVID-19 etiology.
Identify the source of the funding for this research project: Dr. Roach and Dr. Chen are supported by a grant from the National Institutes of Health for advanced heart disease research (T32HL116273).
