Lung transplant feasible for severe COVID-19

Lung transplants were successfully used to save some COVID-19 patients who developed acute respiratory distress syndrome, it has been revealed.

The procedure was used in at least four countries last year on 12 patients, doctors reported.

The paper appeared in the Lancet Respiratory Medicine recently. It outlines the conditions under which such a transplant can be considered and covers in detail the early outcomes of 12 patients.

Dr Konrad Hoetzenecker, of MedUni Vienna, Austria, and colleagues explain that lung transplant is rarely considered for patients with acute respiratory distress due to infections.

The patients they describe showed severe lung disease from COVID-19 and were deemed at imminent risk of dying. They underwent bilateral lung transplant at hospitals in the USA, Italy, Austria and India from May to September 2020. They were mostly in middle age and a quarter were female.

"The lung transplant procedure was technically challenging," write the authors, but "there was no recurrence of SARS-CoV-2 in the allografts." Their survival rates were similar to those for transplant recipients without a virus.

"Lung transplantation is the only option for survival in some patients with severe, unresolving COVID-19-associated acute respiratory distress syndrome, and the procedure can be done successfully, with good early post-transplantation outcomes, in carefully selected patients," they report.

The team say that potential patients should have exhausted all conservative treatment options, show no recovery of COVID-19-damaged lungs despite at least four weeks of ventilation, be aged below 65 with no major comorbidities, and be in good physical condition.

Dr Hoetzenecker said: "These guidelines can be applied worldwide for making a sound selection of patients who are suitable for a lung transplant following a COVID-19 infection."

Bharat, A. et al. Early outcomes after lung transplantation for severe COVID-19: a series of the first consecutive cases from four countries. The Lancet Respiratory Medicine 31 March 2021 doi: 10.1016/S2213-2600(21)00077-1


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