Lung transplantation during the outbreak of Coronavirus disease 2019 (COVID-19) in China

Bo, Wu; Man, Huang; Guohui, Jiao; Chunxiao, Hu; Yi, Yang; Jingyu, Chen

Objectives To illustrate our workflow for lung donation and transplantation during the COVID-19 crisis and report our preliminary experience with perioperative care. Methods We retrospectively analyzed data in the China Lung Transplantation Registration from January 23rd, 2020, to March 23rd, 2020 (2020 cohort), compared to the same period in 2019 (2019 cohort). Pre- and post-lung transplantation (LTx) management strategies, including measures aiming to prevent SARS-CoV-2 infection, were applied for all recipients, including five post-COVID-19 transplants during the COVID-19 pandemic period in China. Results Twenty-eight LTx procedures were performed, including LTx for five patients with acute respiratory distress syndrome (ARDS) due to COVID-19-related pulmonary fibrosis. Compared to the 2019 cohort, more patients with urgent conditions were transplanted in 2020, with a shorter pre-LTx admission time and early mobilization post-LTx. A large proportion (60%) of lung donations were transported on high-speed trains and commercial flights or commercial flights and highways. Grafts in the preservation containers were handed over to the receiving staff at the airport for 40% (10/25) of donations, which reduced the unnecessary quarantine of transporting staff entering the city. Listed candidates were urgently transferred to other qualified centers in 17.9% (5/28) of cases, which reduced the risk of SARS-CoV-2 exposure in COVID-19 designated hospitals. The 90-day survival rate of the recipients transplanted in 2020 was 85.7%, including 3 of 5 (60%) recipients who were critically severe COVID-19 patients. Conclusion LTx and lung donation amid COVID-19 can be performed safely with coordinated efforts on medical resource sharing and medical staff protection based on stratification of the infection risk. Outcomes were not compromised during the COVID-19 outbreak. LTx can be regarded as salvage therapy for critical COVID-19 patients with a confirmed positive-turned-negative virology status.