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New positive outcomes in COVID-19 patients who underwent lung transplants

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For many COVID-19 patients with irrecoverable lung damage, transplantation is the only option for survival. However, there is limited information about the long-term outcomes of these patients, including postoperative complications, hospital length of stay and survival. A new study published in the Journal of the American Medical Association (JAMA) shows positive outcomes in the first 30 consecutive COVID-19 patients who underwent a lung transplant at Northwestern Medicine in Chicago. The outcomes for Northwestern Medicine COVID-19 lung transplant patients are validated by a concurrent paper in New England Journal of Medicine (NEJM) which reports national outcomes at experienced transplant centers.              

Among the 102 consecutive lung transplant recipients at Northwestern Medicine from January 21, 2020, to September 30, 2021, 30 patients were transplanted due to COVID-19 and 72 patients were transplanted due to chronic end-stage lung disease including cystic fibrosis, pulmonary hypertension, idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease. The JAMA study found:

COVID-19 PATIENTSNON-COVID PATIENTS
–          30 patients were transplanted–          72 patients were transplanted
–          17 men, 13 women–          40 men, 32 women
–          Median age: 53–          Median age: 62
–          Waitlist time: 11.5 days–          Waitlist time: 15 days
–          ECMO was used in 57% of patients–          ECMO was used in 1% of patients
–          During transplant, patients received a 

           median of 6.5 units of packed red blood cells
–          During transplant, patients received a 

           median of 0 units of packed red blood cells
–          Median operation time was 8.5 hours–          Median operation time was 7.4 hours
–          Post-transplant median duration of hospitalization was 28.5 days–          Post-transplant median duration of hospitalization was 16 days
–          0% developed lung rejection–          12% developed lung rejection
–          100% of patients were alive at the time 

           the JAMA article was written; current mortality remains above 90%
–          At follow-up after transplant (488 days

           median), 83% of patients were alive

“This study proves lung transplantation is highly effective and successful in critically-ill COVID-19 patients. We were especially surprised to find that patients with COVID-19 did not develop rejection of the lungs after transplant,” said Ankit Bharat, MD, chief of thoracic surgery at Northwestern Medicine and executive director of the Canning Thoracic Institute. “We hope lung transplantation will become a standard treatment of care when all other medical therapies fail to achieve lung recovery and get the patients off the ventilator and extracorporeal membrane oxygenation (ECMO), a life support machine that does the work of the heart and lungs. We also hope patients aren’t declined access to this lifesaving intervention due to insurance denials.” 

“As shown in the study, COVID-19 lung transplant procedures are much more difficult and require more resources. These procedures are only going to be successful when done at select transplant centers with high levels of experience and necessary resources,” said Scott Budinger, MD, chief of pulmonary and critical care medicine at Northwestern Medicine and medical director of the Canning Thoracic Institute. “While these are lifesaving procedures, they carry substantial risk. Patients need to take medications for the rest of their lives and despite that, they will eventually reject their lungs. Transplant centers should be selective in who they consider for COVID-19 lung transplant procedures, and patients should seek a second opinion when declined for transplant because not all centers have the expertise to perform them.”

In June 2020, Northwestern Medicine surgeons performed the first lung transplant on a COVID-19 patient in the United States. To date, 40 COVID-19 patients have received lung transplants at Northwestern Medicine.

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About the author

editor

Editor in chief for eTurboNew is Linda Hohnholz. She is based in the eTN HQ in Honolulu, Hawaii.

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