tetano
Editor, Senior Moderator
Ann Transplant
. 2024 Dec 24:29:e946088.
doi: 10.12659/AOT.946088. Lung Transplant Success in COVID-19 Patients Requiring V-V ECMO: One-Year Follow-Up
Mazen F Odish[SUP] 1 [/SUP], Travis Pollema[SUP] 2 [/SUP], Christine M Lin[SUP] 1 [/SUP], Robert L Owens[SUP] 1 [/SUP], Cassia Yi[SUP] 2 [/SUP], Shannon LeBlanc[SUP] 1 [/SUP], Chelsea Roche[SUP] 1 [/SUP], Catherine Gaissert[SUP] 1 [/SUP], Gordon Yung[SUP] 1 [/SUP], Aarya Kafi[SUP] 1 [/SUP], Eugene M Golts[SUP] 2 [/SUP], Kamyar Afshar[SUP] 1 [/SUP]
Affiliations
BACKGROUND Acute respiratory distress syndrome (ARDS) due to coronavirus 2019 (COVID-19) can result in severe disease requiring mechanical ventilatory support. A subset of these patients, however, demonstrate refractory hypoxemia/hypercarbia requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO) as adjunctive therapy. The primary goal of V-V ECMO is a "bridge" to recovery of native lung function; however, patients may progress to irreversible pulmonary damage requiring lung transplantation. MATERIAL AND METHODS We conducted a retrospective review of patients with refractory COVID-19 ARDS/pulmonary fibrosis that required a V-V ECMO bridge to lung transplantation at our institution from May 2021 to December 2022. Data for analysis included patient demographics, pre/post-transplantation course, and 1-year outcomes. RESULTS Nine patients (6 male, 3 female) with an average age of 44.6±12.1 years required V-V ECMO support for COVID-19 and subsequently underwent lung transplantation. The median number of ECMO days was 57 (IQR 53-78). At listing, these patients had a median lung allocation score (LAS) of 91.86 (IQR 89.05-92.13). The median hospital length-of-stay was 89 days (IQR 54-144) with the longest hospital stay at 255 days. All patients were discharged home and survived to 1-year post-transplant. CONCLUSIONS Our case series shows that patients with COVID-19 ARDS/pulmonary fibrosis had no meaningful difference in overall survival compared to our institution's overall 1-year lung transplant survival rate. Our results suggest that with careful selection and care, long-term lung transplantation outcomes can be equivalent for those requiring a bridge to transplantation with V-V ECMO support despite the severity of illness in the peri-transplant period.
. 2024 Dec 24:29:e946088.
doi: 10.12659/AOT.946088. Lung Transplant Success in COVID-19 Patients Requiring V-V ECMO: One-Year Follow-Up
Mazen F Odish[SUP] 1 [/SUP], Travis Pollema[SUP] 2 [/SUP], Christine M Lin[SUP] 1 [/SUP], Robert L Owens[SUP] 1 [/SUP], Cassia Yi[SUP] 2 [/SUP], Shannon LeBlanc[SUP] 1 [/SUP], Chelsea Roche[SUP] 1 [/SUP], Catherine Gaissert[SUP] 1 [/SUP], Gordon Yung[SUP] 1 [/SUP], Aarya Kafi[SUP] 1 [/SUP], Eugene M Golts[SUP] 2 [/SUP], Kamyar Afshar[SUP] 1 [/SUP]
Affiliations
- PMID: 39716460
- DOI: 10.12659/AOT.946088
BACKGROUND Acute respiratory distress syndrome (ARDS) due to coronavirus 2019 (COVID-19) can result in severe disease requiring mechanical ventilatory support. A subset of these patients, however, demonstrate refractory hypoxemia/hypercarbia requiring veno-venous extracorporeal membrane oxygenation (V-V ECMO) as adjunctive therapy. The primary goal of V-V ECMO is a "bridge" to recovery of native lung function; however, patients may progress to irreversible pulmonary damage requiring lung transplantation. MATERIAL AND METHODS We conducted a retrospective review of patients with refractory COVID-19 ARDS/pulmonary fibrosis that required a V-V ECMO bridge to lung transplantation at our institution from May 2021 to December 2022. Data for analysis included patient demographics, pre/post-transplantation course, and 1-year outcomes. RESULTS Nine patients (6 male, 3 female) with an average age of 44.6±12.1 years required V-V ECMO support for COVID-19 and subsequently underwent lung transplantation. The median number of ECMO days was 57 (IQR 53-78). At listing, these patients had a median lung allocation score (LAS) of 91.86 (IQR 89.05-92.13). The median hospital length-of-stay was 89 days (IQR 54-144) with the longest hospital stay at 255 days. All patients were discharged home and survived to 1-year post-transplant. CONCLUSIONS Our case series shows that patients with COVID-19 ARDS/pulmonary fibrosis had no meaningful difference in overall survival compared to our institution's overall 1-year lung transplant survival rate. Our results suggest that with careful selection and care, long-term lung transplantation outcomes can be equivalent for those requiring a bridge to transplantation with V-V ECMO support despite the severity of illness in the peri-transplant period.