Department of Cardiothoracic Surgery, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA.
Division of Pulmonology and Critical Care, Mayo Clinic Arizona, Phoenix, AZ, USA.
Lung. 2024 Oct;202(5):723-737. doi: 10.1007/s00408-024-00724-z. Epub 2024 Jun 27.
Lung transplantation (LTx) is a potential intervention for end-stage COVID-19 lung disease. Current literature is sparse regarding the outcomes of LTx for COVID-19 related acute respiratory distress syndrome (ARDS) and pulmonary fibrosis (PF). This study aims to characterize outcomes and patterns of LTx for COVID-19 related lung disease throughout the pandemic.
Patients who underwent LTx during the pandemic for COVID-19 related lung disease were retrospectively identified using the UNOS registry. Demographics, as well as outcomes measures and nationwide patterns of care were collected and analyzed.
A total of 510 adult cases of LTx for COVID-19 (259 ARDS, 251 PF) were compared to 4,031 without COVID-19 (3,994 PF, 37 ARDS). Patients who received LTx for COVID-19 ARDS did not differ in 2-year survival when compared to those with COVID-19 PF (81.9% vs 77.2%, p = 0.4428). Compared to non-COVID-19 etiologies, COVID-19 ARDS patients had higher rates of stroke (2.3% vs 0%, p = 0.0005), lower rates of graft failure (12.8% vs 36.1%, p = 0.0003) and post-transplant ECMO (29.6% vs 41.7%, p = 0.0002), and improved 2-year survival following LTx (81.9% vs 61.7%, p = 0.0064). No difference in 2-year survival following LTx was observed between patients with COVID-19 and non-COVID-19 PF (77.2% vs 71.8%, p = 0.34). Rates of LTx spiked with variant emergence and declined with rounds of vaccination.
Our results are consistent with early reports of survival outcomes following LTx for COVID-19 ARDS and PF while providing an increased layer of granularity. LTx may be considered as a safe and effective intervention for COVID-19 lung disease.
肺移植（LTx）是治疗终末期 COVID-19 肺部疾病的一种潜在干预手段。目前关于 LTx 治疗 COVID-19 相关急性呼吸窘迫综合征（ARDS）和肺纤维化（PF）的文献很少。本研究旨在描述大流行期间 LTx 治疗 COVID-19 相关肺部疾病的结果和模式。
使用 UNOS 注册中心回顾性确定大流行期间因 COVID-19 相关肺部疾病而接受 LTx 的患者。收集并分析人口统计学资料以及结局指标和全国范围内的护理模式。
共比较了 510 例成人 COVID-19 （259 例 ARDS，251 例 PF）和 4031 例非 COVID-19 （3994 例 PF，37 例 ARDS）LTx 患者。与 COVID-19 PF 患者相比，接受 LTx 治疗 COVID-19 ARDS 的患者 2 年生存率无差异（81.9%比 77.2%，p=0.4428）。与非 COVID-19 病因相比，COVID-19 ARDS 患者中风发生率较高（2.3%比 0%，p=0.0005），移植物失功率较低（12.8%比 36.1%，p=0.0003），LTx 后 ECMO 使用率较低（29.6%比 41.7%，p=0.0002），LTx 后 2 年生存率较高（81.9%比 61.7%，p=0.0064）。COVID-19 与非 COVID-19 PF 患者 LTx 后 2 年生存率无差异（77.2%比 71.8%，p=0.34）。随着变异株的出现，LTx 数量激增，随着疫苗接种次数的增加而下降。
我们的结果与早期关于 COVID-19 ARDS 和 PF 接受 LTx 后的生存结果报告一致，同时提供了更详细的分析。LTx 可被视为治疗 COVID-19 肺部疾病的一种安全有效的干预手段。
