63. The Early Outcome of Lung Transplantation with the Lung Allografts from the Donors Tested Positive for COVID-19
University of Michigan Hospital
Ann Arbor, MI
United States - Contact Me
Jules Lin, M.D. is a Professor in the Section of Thoracic Surgery at the University of Michigan and the Mark B. Orringer Research Professor. He is the Associate Chief Clinical Officer, CV/Neuro. He is involved in establishing national guidelines as a member of the National Comprehensive Cancer Network (NCCN) Non-Small Cell Lung Cancer, Mesothelioma, and Thymoma Guideline Panels, is the Chair and Section Editor for the Society of Thoracic Surgeons, Curriculum Task Force, and is a Features Editor for the Journal of Thoracic and Cardiovascular Surgery. He specializes in general thoracic surgery and has an interest in minimally invasive approaches in the treatment of lung and esophageal diseases as well as lung transplantation. His research interests include investigating the molecular biology of esophageal carcinoma and mechanisms behind chemoresistance. He is also evaluating the use of morphomic analysis of CT scans to identify differences in body composition associated with frailty and whether these morphomic factors can predict outcomes after thoracic surgery.
University of Southern California Keck School of Medicine
Pittsburgh, PA
United States - Contact Me
Dr. Harano is a thoracic surgeon at Division of General Thoracic Surgery, Keck School of Medicine, University of Southern California. He graduated from Kumamoto University School of Medicine and was trained at Toranomon Hospital in Tokyo, Japan and Brigham and Women’s Hospital in Boston. Subsequently he completed cardiothoracic transpalnt fellowship at Universuty of Pittsburgh Medical Center. His clinical interests focus on minimally invasive thoracic surgery and lung transplantation. He is board-certified by the Japanese Association for Chest Surgery.
Abstract
COVID-19 can be detected for extended periods of time with nucleic acid test (NAT) even after the virulence and transmissibility become negligible. The lung allograft from the donor who tested positive for COVID-19 has been used for transplantation in highly selected cases. This study aimed to clarify the early outcomes of lung transplantation with COVID-19-positive donors.
Methods: The Organ Procurement and Transplantation Network/United Network for Organ Sharing data between April 2020 and June 2022 was retrospectively analyzed. Multiorgan transplantation was excluded from the analysis.
Results: In the study periods, 29,944 donors were identified, including 1,297 COVID-19-positive donors (4.3%). The lungs were transplanted from 47 donors (3.6%), whereas 296 hearts (22.8%), 733 livers (56.5%), and 1772 kidneys (68.3%) were transplanted. Of these 47 lung donors, COVID-19 was diagnosed with NAT in 22 cases (46.8%). Among the transplanted cases, compared to the lung donors without COVID-19 infection (n=5,433), the COVID-19-positive lung donors are younger (28.4±11.6 years vs. 35.4±13.6 years, p<0.001). On the other hand, the recipients who received the lungs from COVID-19-positive lung allografts (COVID-positive group, n=47) had higher LAS (57.1±23.0 vs. 50.9±20.0, p=0.033) comparing to the recipients who received COVID-19-negative lung allografts (COVID-negative group, n=5,501). The rate of ECMO bridge to lung transplantation (14.9% [7/47] vs. 8.9% [490/5,501], p=0.19) and the waiting time on the waitlist (median 29 days vs. 31 days, p=0.70) were comparable between the two groups. The COVID-positive group are more frequently underwent double lung transplantation (91.5% [43/47] vs 79.5% [4,371/5,501], p=0.044). The post-transplant length of hospital stay (median 16 days vs 19 days, p=0.52), needs of ECMO at 72 hours after transplantation (2.6% [1/38] vs 10.4% [541/5,184], p=0.18), survival outcomes (n = 5,226; logrank test p = 0.48) were comparable between the two group.
Conclusions:
Carefully selected lung allografts from COVID-19-positive donors had comparable early post-transplant outcomes to the lung allografts from COVID-19-negative donors.