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. 2023 Oct;116(4):819-828.
doi: 10.1016/j.athoracsur.2022.09.039. Epub 2022 Oct 10.

A Matched Survival Analysis of Lung Transplant Recipients With Coronavirus Disease 2019-Related Respiratory Failure

Kyle Freischlag  1 , Thomas J Lynch  1 , Vitaly Ievlev  2 , Caitlyn Gries  2 , John C Keech  1 , Evgeny V Arshava  1 , Tahuanty Pena  3 , Julia A Klesney-Tait  3 , Kalpaj R Parekh  4
Affiliations

A Matched Survival Analysis of Lung Transplant Recipients With Coronavirus Disease 2019-Related Respiratory Failure

Kyle Freischlag et al. Ann Thorac Surg. 2023 Oct.

Abstract

Background: Lung transplantation is an acceptable and potentially life-saving treatment option for coronavirus disease 2019 (COVID-19)-induced acute respiratory distress syndrome and pulmonary fibrosis. This study was conducted to determine whether recipients of lung transplantation (LT) for COVID-19-related lung disease have comparable outcomes to other recipients with a similar level of lung dysfunction.

Methods: The Organ Procurement and Transplant Network database was queried for adult LT candidates between 2006 and 2021. Recipients with COVID-19-related respiratory failure were matched 1:2 using a nearest-neighbor algorithm. Kaplan-Meier methods with log-rank tests were used to compare long-term survival. A proportional hazards model was used to calculate risk of death.

Results: A total of 37,333 LT candidates from all causes were compared with 334 candidates from COVID-19-related respiratory failure. COVID-19 recipients were more likely to be younger (50 vs 57 years, P < .001), male (79% vs 60%, P < .001), require extracorporeal membrane oxygenation (56.3% vs 4.0%, P < .001), and have worse lung function (lung allocation score, 82.4 vs 47.8; P < .001) at transplantation. Subsequently, 227 COVID-19 recipients were matched with 454 controls. Patients who received a transplant for COVID-19 had similar rates of mechanical ventilation, extracorporeal membrane oxygenation, postoperative complications, and functional status at discharge compared with controls. There was no difference in overall survival or risk of death from COVID-19 (hazard ratio, 0.82; 95% CI, 0.45-1.53; P = .54).

Conclusions: Six-month survival for recipients of LT for COVID-19-related respiratory failure was comparable to that of other LT recipients.

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Figures

Figure 1
Figure 1
Consolidated Standards of Reporting Trials (CONSORT) diagram for coronavirus disease 2019 (COVID-19)–related respiratory failure.
Figure 2
Figure 2
Standardized mean differences (SMDs) in baseline covariates before and after matching. (BMI, body mass index; ECMO, extracorporeal membrane oxygenation; UNOS, United Network of Organ Sharing.)
Figure 3
Figure 3
Cumulative incidence of death and transplant for transplant candidates. (COVID-19, coronavirus disease 2019).
Figure 4
Figure 4
Kaplan-Meier survival analysis of recipients for coronavirus disease 2019 (COVID-19)–related respiratory failure compared with all recipients. The shaded areas indicate the 95% CI.
Figure 5
Figure 5
Kaplan-Meier survival analysis of recipients for coronavirus disease 2019 (COVID-19)–related respiratory failure compared with matched recipients. Shaded areas indicate the 95% CI.
See this image and copyright information in PMC

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