International Experience with Lung Transplantation for COVID-19 Associated Acute Respiratory Distress Syndrome

Machuca, T. N.; Bharat, A.; Kurihara, C.; Jr, R. Garza-Castillon; Kim, S.; Manerikar, A.; Pelaez, A.; Pipkin, M.; Shahmohammadi, A.; Rackauskas, M.; KG, S.; Balakrishnan, K.; Jindal, A.; Schaheen, L.; Hashimi, S.; Bhuddhdev, B.; Arjuna, A.; Rosso, L.; Palleschi, A.; Lang, C.; Jaksch, P.; Nosotti, M.; Hoetzenecker, K.

Purpose The COVID-19 pandemic has infected millions of people across the world and caused several thousands of deaths. Given advances in extracorporeal life support technology, ECMO for COVID-19 acute respiratory distress syndrome (ARDS) has proven to be successful in sustaining life, however, has left a significant number of patients fully depended on devices and incapable of being weaned. Lung transplantation, as a well-established therapy for end-stage lung disease, has been considered for some patients with COVID-19 ARDS in the absence of lung recovery and the presence of findings suggestive of end-stage lung disease. Methods This is an International collaborative effort to assess the role of lung transplantation in COVID-19 ARDS. There is worldwide representation with centers from US (3), Europe (2) and Asia (1). Patients with COVID-19 ARDS supported on ECMO and/or mechanical ventilation who were deemed unweanable and developed features of end-stage lung disease were evaluated for lung transplantation. We followed ISHLT conventional recipient selection criteria recommendations and a 2 negative COVID-19 PCRs from bronchoalveaolar lavage or viral culture depending on medical urgency. Endpoints We will present demographics, intraoperative challenges, primary graft dysfunction, postoperative complications, survival and functional outcomes of patients with COVID-19 ARDS who underwent lung transplantation. Additionally, referral patterns, reasons for listing denial and waitlist outcomes will be presented. So far, this collaborative group has transplanted 17 patients. There have been no deaths on the waitlist, there was one post-transplant mortality at day 61. Ten patients have been discharged from the hospital and are doing well. Six patients are recovering well however less than 30 days post-transplantation and remain admitted.