Lung Transplantation for COVID-19 Related Lung Disease: A Follow-Up Study of Outcomes from a Medium-Size Lung Transplant Programd

In the United States of America, COVID-19 acute respiratory distress syndrome (ARDS) and post-COVID pulmonary fibrosis (PCPF) are raising indications for lung transplant (LT). Another indication for LT is underlying fibrosis with SARS-CoV-2 induced interstitial lung disease exacerbation or rapid progressing fibrosis. Only a few centers have reported on their long-term outcomes after LT for COVID-19. Single center retrospective chart review of patients transplanted for COVID-19 related lung disease. The Henry Ford Health System Institutional Board Review Board approved this study as minimal-risk research using data collected for routine clinical practice (#14953). During the study period from January 2021 to June 2023, 12 patients underwent bilateral LT for COVID-19 related lung disease: 6 for COVID-19 ARDS, 4 with worsening of idiopathic pulmonary fibrosis (IPF) and 2 for PCPF. Median survival after LT in months are 18.5 (IQR 12.9, 26) for ARDS; 20.5 (IQR 13.1, 26) for IPF; and 12.6 months for PCPF. Hospital discharge survival was 83% for ARDS and 100% for the fibrotic types of lung disease. The 30-day and 3-month survival was 100% and 91%, respectively, for all COVID-19 related lung diseases. At the time of data collection, 3 patients in this cohort died (2 in the ARDS group). Eight patients were alive over 1-year post-transplant (4 ARDS, 3 patients with IPF prior to COVID-19 and 1 patient with PCPF). LT for COVID-19 related lung disease is associated with several challenges from patient selection to perioperative management. Short- and long-term survival is promising but associated with significant morbidity.