Lung Transplantation for COVID-19 vs Other Causes Have Similar Survival Rates

Patients receiving lung transplantation for COVID-19-related respiratory disease have similar rates of 6-month post-transplant survival as patients receiving lung transplantation for other causes, according to study findings published in The Annals of Thoracic Surgery.

Researchers sought to determine whether recipients of LT for COVID-19-related lung disease have comparable outcomes to recipients of LT for other reasons who have similar levels of lung dysfunction. The researchers hypothesized that those receiving COVID-19 related LT would incur worse short-term outcomes but have similar long-term survival compared to a matched control group.

The investigators conducted a retrospective review of adult lung transplant candidates in the Organ Procurement and Transplant Network database from January 2006 through December 2021, identifying 37,333 US candidates for all-cause LT.  Those who were candidates for LT unrelated to COVID-19 were matched 2:1 using a nearest-neighbor algorithm with 334 candidates for LT due to COVID-19-related respiratory failure.

Overall, candidates with COVID-19 were more likely to be male (79% vs 60%; P <.001), younger (50 vs 57 years; P <.001), have worse lung function (lung allocation score 82.4 vs 47.8; P <.001) and require extracorporeal membrane oxygenation (ECMO) (56.3% vs. 4.0%; P <0.001) at transplantation. At 6 months, the researchers found that almost 88% of COVID-19 candidates had received transplant vs 63% of all candidates. Moreover, candidates on the waitlist with COVID-19 respiratory failure showed a significantly lower mortality risk (hazard ratio [HR] 0.169; 95% CI, 0.086-0.329; P <.001) and patients spent less time on the waitlist (COVID-19 patients 26.4 days vs other candidates 191.3 days; P <.001). There was no significant difference in the lifetime odds of receiving a transplant for COVID-19 candidates vs other candidates (odds ratio 1.02; 95% CI, 0.79-1.32; P =.90).

The assessment of LT recipients included 227 recipients of COVID-19 LT and a matched control group of 454 recipients of  LT for other causes. The 2 groups had similar rates of mechanical ventilation, postoperative complications, ECMO, and functional status at discharge.

Researchers found no significant difference in overall survival at 6 months between recipients of LT for COVID-19-related lung disease (94.4%) vs the matched control group (88.1%) (P =.26). Likewise, no difference was found in risk-adjusted mortality from COVID-19 (HR 0.82; 95% CI, 0.45-1.53; P =.54).

No significant difference was found in the overall survival probability at 6 months between LT recipients with COVID-19 (94.1%) and the total recipient population (92.1%) (P =.91). The researchers also found no overall association between COVID-19 diagnosis at transplant and greater risk of mortality (HR 1.06; 95% CI, 0.612-1.838; P =.834).

Review limitations include the retrospective design; selection bias; transplant centers’  varying criteria for listing and transplanting patients with COVID-19; no analysis of patients with COVID-19 not listed for transplantation; and failure to capture differences in pre-transplant selection and post-transplant care with granularity.

Researchers noted that candidates listed for LT had considerably shorter waitlist times and higher acuity of illness with COVID-19-related respiratory failure.

The investigators concluded that “Early survival for recipients of LT for Covid-19-related respiratory failure was comparable to that of other lung transplantation recipients. Candidates listed for LT for Covid-19-related respiratory failure had higher acuity of illness at listing and had notably shorter waitlist times. When matched with patients with similar characteristics and level of lung dysfunction, there were comparable similar short- and long-term outcomes.”

“Six-month survival for recipients of LT for Covid-19-related respiratory failure was comparable to that of other lung transplantation recipients,” and that “When matched with patients with similar characteristics and level of lung dysfunction, there were comparable similar short- and long-term outcomes.” Thus, some patients with COVID-19 respiratory disease at end-stage, if carefully selected, may still benefit from transplantation, said the study authors.