Timing of Lung Transplant Referral in Patients with Severe COVID-19 Lung Injury Supported by ECMO

Author:

Levy Liran12,Deri Ofir12ORCID,Huszti Ella3,Nachum Eyal14,Ledot Stephane145,Shimoni Nir145,Saute Milton16,Sternik Leonid14,Kremer Ran16,Kassif Yigal14,Zeitlin Nona16,Frogel Jonathan15,Lambrikov Ilya15,Matskovski Ilia15,Chatterji Sumit12,Seluk Lior12,Furie Nadav12,Shafran Inbal12,Mass Ronen12,Onn Amir12,Raanani Ehud14,Grinberg Amir7,Levy Yuval7ORCID,Afek Arnon7,Kreiss Yitshak7,Kogan Alexander14

Affiliation:

1. The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel

2. Institute of Pulmonary Medicine, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel

3. Biostatistics Research Unit, University Health Network, Toronto, ON M5G 1X6, Canada

4. Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel

5. Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel

6. Department of Thoracic Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel

7. General Management, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel

Abstract

Severe respiratory failure caused by COVID-19 often requires mechanical ventilation, including extracorporeal membrane oxygenation (ECMO). In rare cases, lung transplantation (LTx) may be considered as a last resort. However, uncertainties remain about patient selection and optimal timing for referral and listing. This retrospective study analyzed patients with severe COVID-19 who were supported by veno-venous ECMO and listed for LTx between July 2020 and June 2022. Out of the 20 patients in the study population, four who underwent LTx were excluded. The clinical characteristics of the remaining 16 patients were compared, including nine who recovered and seven who died while awaiting LTx. The median duration from hospitalization to listing was 85.5 days, and the median duration on the waitlist was 25.5 days. Younger age was significantly associated with a higher likelihood of recovery without LTx after a median of 59 days on ECMO, compared to those who died at a median of 99 days. In patients with severe COVID-19-induced lung damage supported by ECMO, referral to LTx should be delayed for 8–10 weeks after ECMO initiation, particularly for younger patients who have a higher probability of spontaneous recovery and may not require LTx.

Publisher

MDPI AG

Subject

General Medicine

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