Lung transplant outcomes after acute respiratory distress syndrome requiring extracorporeal life support: Lessons from the COVID-19 pandemic

Mallory L Hunt; Maria M Crespo; Thomas J Richards; Francisca Bermudez; Andrew Courtwright; Asad Usman; Audrey E Spelde; Joshua Diamond; Namrata Patel; Edward Cantu; Jason Christie; Emily Clausen; Marisa Cevasco; Vivek Ahya; Christian A Bermudez

doi:10.1016/j.jtcvs.2023.12.028

Lung transplant outcomes after acute respiratory distress syndrome requiring extracorporeal life support: Lessons from the COVID-19 pandemic

J Thorac Cardiovasc Surg. 2024 Jan 8:S0022-5223(24)00010-2. doi: 10.1016/j.jtcvs.2023.12.028. Online ahead of print.

Authors

Affiliations

¹ Divison of Cardiac Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
² Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pa.
³ Georgetown University School of Medicine, Washington, DC.
⁴ Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pa.
⁵ Divison of Cardiac Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa. Electronic address: Christian.bermudez@pennmedicine.upenn.edu.

PMID: 38199292
DOI: 10.1016/j.jtcvs.2023.12.028

Abstract

Objective: Lung transplant for acute respiratory distress syndrome in patients supported with extracorporeal membrane oxygenation was rare before 2020, but was rapidly adopted to rescue patients with COVID-19 with lung failure. This study aims to compare the outcomes of patients who underwent lung transplant for COVID-associated acute respiratory distress syndrome and non-COVID acute respiratory distress syndrome, and to assess the impact of type and duration of extracorporeal membrane oxygenation support on survival.

Methods: Using the United Network for Organ Sharing database, we identified 311 patients with acute respiratory distress syndrome who underwent lung transplant from 2007 to 2022 and performed a retrospective analysis of the patients who required extracorporeal membrane oxygenation preoperatively, stratified by COVID-associated acute respiratory distress syndrome and non-COVID acute respiratory distress syndrome listing diagnoses. The primary outcome was 1-year survival. Secondary outcomes included the effect of type and duration of extracorporeal membrane oxygenation on survival.

Results: During the study period, 236 patients with acute respiratory distress syndrome and preoperative extracorporeal membrane oxygenation underwent lung transplant; 181 patients had a listing diagnosis of COVID-associated acute respiratory distress syndrome (77%), and 55 patients had a listing diagnosis of non-COVID acute respiratory distress syndrome (23%). Patients with COVID-associated acute respiratory distress syndrome were older, were more likely to be female, had higher body mass index, and spent longer on the waitlist (all P < .02) than patients with non-COVID acute respiratory distress syndrome. The 2 groups had similar 1-year survival (85.8% vs 81.1%, P = .2) with no differences in postoperative complications. Patients with COVID-associated acute respiratory distress syndrome required longer times on extracorporeal membrane oxygenation pretransplant (P = .02), but duration of extracorporeal membrane oxygenation support was not a predictor of 1-year survival (P = .2).

Conclusions: Despite prolonged periods of pretransplant extracorporeal membrane oxygenation support, selected patients with acute respiratory distress syndrome can undergo lung transplant safely with acceptable short-term outcomes. Appropriate selection criteria and long-term implications require further analysis.

Keywords: ARDS; COVID-19; extracorporeal membrane oxygenation.