Patients who underwent lung transplantation for COVID-19-associated end-stage lung disease had a similar 1-year overall survival compared with others undergoing lung transplantation, according to a study in Clinical Infectious Diseases.
Researchers sought to determine the characteristics of US patients receiving lung transplantation for COVID-19-related end-stage lung disease, assess long- and short-term outcomes, and compare these outcomes with those of patients whose lung transplantations were for reasons unrelated to COVID-19.
The investigators reviewed data from deceased donors in the deidentified United Network for Organ Sharing (UNOS) database between August 2020 and June 2022. Participants were adults (aged ≥18 years) who underwent a lung transplantation.
A total of 400 lung transplants for COVID-associated end-stage lung disease were recorded, which represented 8.7% of all lung transplants in the US during that period, with the number steadily increasing in 2021.
In comparing those who received a lung transplant due to COVID-19 (ie, the COVID group vs those receiving a transplant for other reasons (ie, the non-COVID group) investigators found that those in the COVID vs non-COVID were younger (51 vs 63 years, P <.001), more frequently male (78% vs 64%, P <.001), and more frequently Hispanic (31% vs 12%). Transplant recipients in the COVID vs non-COVID group also had a higher diabetes incidence (25% vs 17%, P <.001) and lung allocation score (88.0 vs 41.2, P <.001).
More recipients with in the COVID vs non-COVID group were in the intensive care unit at the time of transplant (74% vs 13%) and were on mechanical ventilation (48% vs 4.0%, P <.001). Transplant recipients in the COVID vs non-COVID group also had a shorter listing time (13 days vs 28 days, P <.001) and needed more double lung transplants (92% vs 79%, P <.001).
The median follow-up was 184 days (range, 50-359) in the COVID group and 196 days (range, 30-364) in the non-COVID group. A longer post-transplant hospital stay was required for recipients in the COVID vs non-COVID group (26 days vs 18 days, P <.001), and more recipients in the COVID group vs non-COVID group required extracorporeal membrane oxygenation 72 hours post-transplant (25% vs 9%, P <.001).
Patients with lung transplant from the COVID group had a 1-year overall survival of 86.6% vs 86.3% in the non-COVID group (P =.45). The 2 groups had a similar 1-year overall survival in a matched cohort (86.2% for COVID group vs 87.1% for non-COVID group; P =.60), as well as similar graft survival (86.2% for COVID group vs 87.1% for non-COVID group; P =.60).
Among patients in the COVID group, 29 deaths occurred during the follow-up, of which 2 (6.9%) were attributed to COVID-19. Of the 418 deaths in the non-COVID group, 39 (9.3%) deaths were attributed to COVID-19. COVID-19 was a leading cause of death during the period, occurring in 9.2% of all lung transplant recipients.
Study limitations include its retrospective nature; unaccounted-for factors that may have affected transplant-related outcomes; limited patient follow-up; and potential variability in data quality. Additionally, data were unavailable regarding COVID-19 onset and symptom duration, time from symptom onset to lung transplantation, patient vaccination status, and use of COVID-19-related treatments and immunosuppression therapies.
“Lung transplantation offers a safe and effective therapeutic option for patients with end-stage lung disease from prior COVID-19 with short-term and long-term outcomes similar to lung transplant recipients of non-COVID etiology,” the investigators concluded.
Disclosure: One of the study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of author disclosures.
Okumura K, Jyothula S, Kaleekal T, Dhand A. One-year outcomes of lung transplantation for COVID-19 associated end stage lung disease in the United States. Clin Infect Dis. Published online February 9, 2023. doi:10.1093/cid/ciad072