Lung transplantation during the outbreak of Coronavirus Disease 2019 in China

Abstract

Objectives: The study objectives were to illustrate our workflow for lung donation and transplantation during the Coronavirus Disease 2019 crisis and to report our preliminary experience with perioperative care.

Methods: We retrospectively analyzed data in the China Lung Transplantation Registration from January 23, 2020, to March 23, 2020 (2020 cohort), compared with the same period in 2019 (2019 cohort). Pre- and post-lung transplantation management strategies, including measures aiming to prevent severe acute respiratory syndrome coronavirus 2 infection, were applied to all recipients, including 5 post-Coronavirus Disease 2019 transplants during the Coronavirus Disease 2019 pandemic period in China.

Results: Twenty-eight lung transplant procedures were performed, including lung transplant for 5 patients with acute respiratory distress syndrome due to Coronavirus Disease 2019-related pulmonary fibrosis. Compared with the 2019 cohort, more patients with urgent conditions received transplantation in 2020, with a shorter pre-lung transplant admission time and early mobilization post-lung transplant. A large proportion (60%) of lung donations were transported on high-speed trains and commercial flights or highways and commercial flights. Grafts in the preservation containers were handed over to the receiving staff at the airport for 40% (10/25) of donations, which reduced the unnecessary quarantine of transporting staff entering the city. Listed candidates were urgently transferred to other qualified centers in 17.9% of cases (5/28), which reduced the risk of severe acute respiratory syndrome coronavirus 2 exposure in Coronavirus Disease 2019-designated hospitals. The 90-day survival of the transplant recipients in 2020 was 85.7%, including 3 of 5 recipients (60%) who had critically severe Coronavirus Disease 2019.

Conclusions: Lung transplant and donation amid Coronavirus Disease 2019 can be performed safely with coordinated efforts on medical resource sharing and medical staff protection based on stratification of the infection risk. Outcomes were not compromised during the Coronavirus Disease 2019 outbreak. Lung transplantion can be regarded as salvage therapy for critical patients with Coronavirus Disease 2019 with a confirmed positive turned negative virology status.

Keywords: COVID-19; China; ECMO; lung transplantation; outcome.

Graphical abstract

Overall survival of LTx recipients by Kaplan–Meier plots comparing the outcome of patients who received a transplant during January 23 to March 23, 2019 (cohort 2019) and 2020 (cohort 2020).

Figure 1

LTx donor and recipient screening and triage workflow. COVID-19, Coronavirus Disease 2019; NAT, nucleic acid test; CT, computed tomography; LTx, lung transplantation; Ig, immunoglobulin.

Figure 2

Kaplan–Meier plots of the overall survival among recipients who were transplanted during January 23 to March 23 in 2019 (2019 cohort) and 2020 (2020 cohort); log-rank P = .083. The overall survival of recipients in the 2020 cohort was not inferior to that of the 2019 cohort during the follow-up period. KM, Kaplan–Meier; CI, confidence interval.

Figure 3

Time points for lung donation during the COVID-19 epidemic and mitigation measures. Diagram of the COVID-19 epidemic trend in cities and the donors' locations are shown separately. Donation dates and order numbers are also indicated. Bottom: Policies that affected the epidemic trend are shown. The data were referenced from National Health Commission (http://www.nhc.gov.cn/xcs/yqtb/list_gzbd_3.shtml) and visualized from https://ncov.dxy.cn/ncovh5/view/en_pneumonia. Existing confirmed case statistics are shown at the provincial level. Trends for existing COVID-19 case volumes are depicted by colored lines. COVID-19, Coronavirus Disease 2019.

Figure E1

Each transplant surgery was consented by qualified LTx centers. The listed patient's information was included in the Chinese Lung Transplant Registry system (http://www.cotr.cn/jsp/login/uLogin.jsp) and received final approval by the National Transplant Medical Review Board (Chinese Lung Transplantation Society and Transplantation Data Management & Quality Control Center).

Figure E2

Comparison of LTx case volume within the same period of 2019 and 2020.

Figure E3

Patients post–COVID-19 who were referred for LTx assessment with computed tomography when available. Patients 1 to 4 were 4 of 5 transplant recipients who had computed tomography preoperatively. Patients 6 to 11 were 6 of 9 referred patients but did not receive transplant with available computed tomography images.