International research outlines early outcomes on lung transplantation for severe COVID-19

Mauri Discharge
Surgical director Tiago Machuca, M.D., Ph.D., (left) and medical director Andres Pelaez, M.D., (right) congratulate a lung transplant patient (center) on his discharge. The research study emphasized the importance of multidisciplinary teams throughout the critical decision-making process.

The UF Health lung transplant team has collaborated with researchers around the world to identify preliminary guidelines for successful transplantation in patients whose lungs have been permanently damaged by the SARS-CoV-2 virus.

In a landmark study published online March 31 in The Lancet Respiratory Medicine, members of the lung transplant program at UF Health, the University of Florida’s academic health center, describe an analysis of early findings from patients who received lung transplants after COVID-19 damaged their lungs beyond repair.

“This is a historic, multi-institutional report,” said Tiago Machuca, M.D., Ph.D., chief of the division of thoracic surgery and surgical director of the lung transplant program at UF Health Shands Hospital, which is noted for having some of the best lung transplant outcomes across the nation and has so far treated 17 patients who had COVID-19 and later required a transplant. “Our paper draws from a series of firsts across different countries to detail findings and recommendations from the experiences of those who sought to give patients hope when very little remained.”

The study distilled information from 12 double lung transplants performed in four countries (the United States, Austria, Italy and India) to identify transplant consideration criteria, recommendations for preoperative and postoperative treatment, and avenues for future research. The median age of the transplant recipients across the different countries was 48 years, and all patients were or had previously been on a form of life support called ECMO, or extracorporeal membrane oxygenation.

“Part of the challenge in transplanting patients who have had the coronavirus is their chances of other complications, like superimposed infections and excessive bleeding, due to the intensity of the illness their bodies have fought,” said Andres Pelaez, M.D., medical director of the lung transplant program and an associate professor of medicine in the UF College of Medicine.

The authors’ recommendations emphasize the importance of transplantation as a valuable treatment option, but one that should be sought after care teams have done their due diligence to determine a transplant is the best — and only — option for patient recovery.

“I think an essential part of moving forward with lung transplantation is an evaluation completed by an expert multidisciplinary team,” said Abbas Shahmohammadi, M.D., an assistant professor of medicine in the UF College of Medicine and a lung transplant specialist on the team. “Each of the high-volume transplant centers included in the study not only drew on the expertise of surgeons, but also on that of pulmonary and critical care physicians along with infectious disease specialists, in crucial decision-making.”

According to the study, the patients’ chest imaging before transplantation displayed severe lung damage that did not improve despite lengthy mechanical ventilation and ECMO. The original lungs’ pathology was characterized by widespread acute lung damage and pulmonary fibrosis, where lung tissue was thickened and scarred.

Upon transplantation, patients could be weaned off mechanical support and had short-term survival outcomes comparable to those of transplant recipients with conventional ailments such as chronic obstructive pulmonary disease, commonly known as  COPD, and interstitial pulmonary fibrosis.

Regardless, the findings from the co-authors’ case series confirm that lung transplantation is the only viable option for survival in certain patients with severe, unrelenting COVID-19-related acute respiratory distress syndrome, or ARDS, a deadly condition that allows fluid to leak into the lungs and evolves with excessive scar tissue.

“This study was, first and foremost, a focus on the feasibility of this treatment, as well as the reproducibility for our colleagues at other centers across the world looking to offer solutions to those who need them most,” Pelaez said.