First lung transplants in COVID-19 patients

The first two reports of COVID-19 infected recipients receiving lung transplants for irreversible respiratory failure were from Chinese groups in Wuxi⁽¹²⁾ and Hangzhou⁽¹³⁾. Both reported on use of lung transplantation as a therapeutic option in acute respiratory distress syndrome (ARDS) for COVID-19-related pulmonary fibrosis or pneumonia, where patients were at imminent risk of progression to irreversible fatal respiratory failure. Four of the five patients survived. Although transplantations were not commenced until PCR results for COVID-19 were negative, the procedures during the early days of the pandemic in China were exceptionally challenging and complex.

An interesting case report about a successful lung transplantation in a COVID-19 patient has emerged from Vienna⁽¹⁴⁾. This challenging sequential bilateral case was performed when RT-PCR results were still positive, although Vero cell cultures confirmed non-infectivity. RT-PCR for SARS-CoV-2 was performed regularly after the transplantation and remained positive until post op. day (POD) 10, but was negative thereafter. This indicates that lung transplantation can be done with positive PCR, provided Vero cell cultures confirm non-infectivity. The authors emphasize however that lung transplantation is an option for only a small proportion of patients with COVID-19: those with irreversibly-damaged lungs.

The first case of COVID-19 after lung transplant in the immediate post-transplant period (post-op. day 6) was also recently reported⁽¹⁵⁾. Diagnosis was confirmed by positive RT-PCR testing, but the PCR values were negative again six days later by POD 12. After several weeks of intensive care support, by POD 57, the patient no longer required ventilation or supplemental oxygen, was relatively stable and improving with physical therapy.

References:

12. Chen J Y, Qiao K , Liu F , et al. Lung transplantation as therapeutic option in acute respiratory distress syndrome for coronavirus disease 2019-related pulmonary fibrosis. Chin Med J. 2020; 133: 1390-1396. Full text at; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7339336/#!po=3.84615 (no abstract available)

13. Han W, Zhu M . Chen J et al, Lung transplantation for elderly patients with end-stage COVID-19 pneumonia. Ann Surg. 2020; 272: e33-e34. Full text at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7188057/ (no abstract available)

14. Lang C, Jaksch P, Hoda MA, Lang G, et al, Lung transplantation for COVID-19-associated acute respiratory distress syndrome in a PCR-positive patient. Lancet Respir Med. 2020 Aug 25:S2213-2600(20)30361-1. doi: 10.1016/S2213-2600(20)30361-1. (link to extract)

15. Keller B C, Le A, Sobhanie M, Colburn N et al. Early COVID-19 infection after lung transplantation. Am J Transplant . 2020 Oct;20(10):2923-2927. doi: 10.1111/ajt.16097. Epub 2020 Jun 11. (link to abstract)

XVIVO Insights PB-2020-10-28