Small study shows 100% success in lung transplants for ARDS associated with COVID-19
According to a study published in JAMA.
The study was done to gain more insight into the long-term outcomes of patients who underwent lung transplantation after contracting ARDS associated with COVID-19. The researchers also included results from patients without COVID-19 who received a lung transplant for end-stage chronic lung disease, including idiopathic pulmonary fibrosis, chronic obstructive pulmonary disease (COPD), cystic fibrosis and pulmonary hypertension. Before the pandemic, patients with these diseases were rarely considered for lung transplants, the authors say.
In 2021, a global group of transplant centers proposed guidelines for lung transplants related to ARDS associated with COVID-19, but they have been applied inconsistently in part due to a lack of clarity on the outcomes to be achieved. long term for these patients.
The retrospective single-center case series included 102 consecutive patients who underwent lung transplantation between January 21, 2020 and September 30, 2021 at Northwestern University Medical Center in Chicago, Illinois. Thirty of these patients were classified as having COVID-19-associated ARDS, while the other 72 had end-stage chronic lung disease, but did not have COVID-19 infection.
For patients with ARDS associated with COVID-19, the median age (interquartile range [IQR]) was 53 (46-59) and 62 (52-69) for people without COVID-19. There were slightly more men than women in each group, and the group without COVID-19 had a notable number of non-Hispanic white patients (63.9%).
The median preoperative Karnofsky performance status score was 30 in the COVID-19 group and 50 in the non-COVID-19 group. Additionally, the median lung allocation scores were 85.8 and 46.7, and the median waiting time for lung transplantation was 11.5 days (IQR, 5.2-26.0) and 15 days (IQR, 6.0-60.0), respectively.
Among the group with ARDS associated with COVID-19, 17 patients were treated with preoperative venovenous extracorporeal membrane oxygenation (ECMO) and 4 received invasive mechanical ventilation immediately before lung transplantation. In the other group, only 1 was treated with ECMO and 2 received invasive mechanical ventilation before the transplant.
During their ICU stay prior to lung transplantation, 29 patients with ARDS associated with COVID-19 received invasive mechanical ventilation and 1 received noninvasive mechanical ventilation. The authors noted that none of these patients were vaccinated against COVID-19 at the time, and only one patient in the non-COVID-19 group was vaccinated at the time.
The proportion of patients reporting a history of hypertension and diabetes was comparable in each group, although more patients in the non-COVID-19 group reported a history of smoking and chronic kidney disease. Additionally, interstitial lung disease and COPD were the most common causes of end-stage chronic lung disease for the non-COVID-19 group.
At the last follow-up date on November 15, 2021, survival was 100% in the 30 patients who had ARDS associated with COVID-19 and 83% for those who were not infected with COVID-19.
The authors noted several study limitations, including small sample size, singular location, and careful selection of lung transplant recipients in patients with COVID-19-associated ARDS.
They also addressed a concern that has been raised regarding the supply of donor lungs.
“Although the offer of double lung transplants to patients with ARDS associated with COVID-19 has the potential to increase the mismatch between supply and demand, this effect has not been documented in the medical literature at this time. day,” the authors said. “During this study, no increase in waitlist mortality was observed in our center’s non-COVID-19 cohort with the introduction of lung transplantation for patients with COVID-19 associated ARDS. 19; however, this needs to be investigated in other centers with a different supply of donor lungs.