135. Lung Transplantation in Patients with COVID-19- The Early National Experience

Objective- The aims of this analysis are to describe the early national experience of COVID-19 patients who received lung transplants (LT) and compare characteristics and short-term outcomes of non-COVID-19 acute respiratory distress syndrome (ARDS) to COVID LT recipients.
Methods- We queried the Organ Procurement and Transplantation database for adults (≥18 years of age) receiving LT from January 2009 to April 1, 2021 with diagnoses of ARDS (diagnosis code 402) or COVID-19 (diagnosis codes 1616, 1617, or presence of "COVID" in open text of diagnosis).
Results- We identified 88 COVID-19 LT recipients: 64% (n = 56) COVID-19 ARDS, 34% COVID-19 fibrosis (n = 30), and 2% (n =2) COVID-19, unspecified. COVID-19 LT recipients were older (p<0.001), more often male (p=0.01), were less frequently dependent on ECMO (p<0.001), had a better functional status (p<0.01), and a lower mean arterial pressure at time of transplant (p = 0.03) than ARDS LT recipients. Limited follow-up data (70% (n = 66) COVID-19 LT recipients had available follow-up data at 30-days post-transplant; 95% (n= 59) COVID-19 LT recipients were alive 30 days postoperatively) suggests that LT is a viable option for COVID-19 patients with irreversible organ damage.
Conclusions- As the SARS-CoV-2 pandemic continues to affect patients and families worldwide, treatment knowledge gaps persist, including the role and effectiveness of lung transplantation. Limited follow-up data suggests that though older, more predominantly male, and less severely functionally compromised at time of transplant than non-COVID-19 ARDS LT recipients, cARDS patients with evidence of irreversible lung damage respond well to LT. As the number of COVID-19 lung transplant patients increases and longer term follow up data becomes available, the role of lung transplantation in the setting of COVID-19 will become better defined and more completely understood.

Isabella Florissi (1), Eric Etchill (1), Iulia Barbur (1), Katherine Giuliano (1), Pali Shah (1), Errol Bush (1), (1) Johns Hopkins Hospital, Baltimore, MD

Konrad Hoetzenecker

Invited Discussant

Konrad Hoetzenecker, MD PhD is a member of the surgical faculty of the Department of Thoracic Surgery, Medical University of Vienna, and the Director of the Vienna Lung Transplant Program. Besides lung transplantation he is specialized in airway surgery and extended thoracic procedures. Dr Hoetzenecker has authored numerous peer-reviewed articles and is an editorial board member of the Journal of Thoracic and Cardiovascular Surgery and the Journal of Heart and Lung Transplantation. Dr Hoetzenecker has been awarded several prizes and grants including the Graham Memorial Traveling Fellowship from the American Association of Thoracic Surgery.

Isabella Florissi

Abstract Presenter

Isabella Florissi is a second year medical student at the Johns Hopkins University School of Medicine currently interested in pursuing a future in cardiothoracic surgery. Her current research interests include organ transplantation and healthcare disparities in access to care. In addition to her academic pursuits, Isabella is a very involved member of her medical school class and greater Baltimore community. Isabella is a member of the leadership board for the Cardiothoracic Surgery Interest Group, the Surgery Interest group, and the Johns Hopkins chapter of Association of Women Surgeons.  Finally, Isabella acts as one of the Community Service chairs on behalf of the Latinx Medical Students Association at Johns Hopkins.

Specialties: Transplant, Treatment/Procedure/Operation/Surgery, Transplantation--Lung, Lung Transplantion, General Thoracic, Thoracic, Lung, Transplant, Anatomy and Conditions, Lung--Other, Treatment/Procedure/Operation/Surgery, Lung, Lung--Other, Lung--Transplantation