Management of lung transplantation in the COVID-19 era-An international survey

Abstract

It is unknown if solid organ transplant recipients are at higher risk for severe COVID-19. The management of a lung transplantation (LTx) program and the therapeutic strategies to adapt the immunosuppressive regimen and antiviral measures is a major issue in the COVID-19 era, but little is known about worldwide practice. We sent out to 180 LTx centers worldwide in June 2020 a survey with 63 questions, both regarding the management of a LTx program in the COVID-19 era and the therapeutic strategies to treat COVID-19 LTx recipients. We received a total of 78 responses from 15 countries. Among participants, 81% declared a reduction of the activity and 47% restricted LTx for urgent cases only. Sixteen centers observed deaths on waiting listed patients and eight centers performed LTx for COVID-19 disease. In 62% of the centers, COVID-19 was diagnosed in LTx recipients, most of them not severe cases. The most common immunosuppressive management included a decreased dose or pausing of the cell cycle inhibitors. Remdesivir, hydroxychloroquine, and azithromycin were the most proposed antiviral strategies. Most of the centers have been affected by the COVID-19 pandemic and proposed an active therapeutic strategy to treat LTx recipients with COVID-19.

Keywords: antibiotic: antiviral; clinical research / practice; immunosuppression / immune modulation; immunosuppressive regimens; infection and infectious agents - viral; infectious disease; lung transplantation / pulmonology; recipient selection; waitlist management.

FIGURE 1

World map representing the lung transplant centers answering the survey. The map was generated with the public R software using the “maps” package. Red dots represent the centers participating in the survey. Gray areas depict countries participating in the survey [Color figure can be viewed at wileyonlinelibrary.com]

FIGURE 2

Number of lung transplantations performed from January to April in 2019 and 2020

FIGURE 3

Questions regarding the indication of a lung transplant in COVID-19 patients. The dots represent the individual response. The boxplot corresponds to the median with the interquartile range (distance between the first and third quartiles); the lower and upper whiskers extend from the hinge to the lowest and highest (respectively) values that are within 1.5 x IQR of the hinge. LTx, lung transplantation

FIGURE 4

Management of immunosuppressive therapy in recipients infected by the SARS-CoV-2. Red bars are the strategies the most frequently adopted. Orange bars are the second most frequent strategies adopted. Decrease if >5 mg = decrease if >5 mg/day of prednisone dose equivalent. Cyclo, cyclosporine; Tacro, tacrolimus; MMF, mycophenolate mofetil; Aza, azathioprine; CNI, calcineurin inhibitors; CCI, cell cycle inhibitors [Color figure can be viewed at wileyonlinelibrary.com]