Lung Transplantation for Severe Post-Coronavirus Disease 2019 Respiratory Failure

Transplantation. 2021 Feb 16. doi: 10.1097/TP.0000000000003706. Online ahead of print.


Background: The COVID-19 pandemic has resulted in more than 72 million cases and 1.6 million deaths. End-stage lung disease from COVID-19 is a new and growing entity that may benefit from lung transplant, however there is limited data on the patient selection, perioperative management and expected outcomes of transplantation for this indication.

Methods: A systematic review of the literature was performed with searches of MEDLINE and Web of Science databases as well the gray literature. All manuscripts, editorials, commentaries and gray literature reports of lung transplantation for COVID related respiratory failure were included. A case from the University of Virginia is described and included in the review.

Results: A total of 27 studies were included; 11 manuscripts, 5 commentaries, and 11 gray literature reports. The total number of transplantations for COVID related lung disease was 21. The mean age was 55 ± 12 years, 16 (76%) were male, and the acuity was high with 85% on extracorporeal membrane oxygenation preoperatively. There was a 95% early survival rate, with one additional late death. There is growing histopathologic evidence for permanent structural damage with no replicating virus at the time of transplantation.

Conclusions: Bilateral lung transplantation is an effective treatment option with reasonable short-term outcomes for patients suffering from end-stage lung failure secondary to COVID-19. However, specific considerations in this new population require a multidisciplinary approach. As we move into the second wave of the COVID-19 global pandemic, lung transplantation will likely have a growing role in management of these complex patients.