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Published on: August 15, 2022
Lung transplantation during the outbreak of Coronavirus Disease 2019 in China
Bo Wu1, Man Huang2, Guohui Jiao1
1Wuxi Lung Transplant Center, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, China.
Insights
Lung transplantation during the COVID-19 pandemic is feasible and safe. This study demonstrates effective workflows and perioperative care, maintaining positive outcomes for lung transplant recipients, including those critically ill with Coronavirus Disease 2019.
Area of Science:
- Medicine
- Surgery
- Pulmonology
Background:
- The Coronavirus Disease 2019 (COVID-19) pandemic presented unprecedented challenges to healthcare systems globally.
- Lung donation and transplantation services faced significant disruptions, necessitating adaptation of established workflows.
Purpose of the Study:
- To outline a workflow for lung donation and transplantation during the COVID-19 crisis.
- To report preliminary findings on perioperative care for lung transplant recipients during the pandemic.
Main Methods:
- Retrospective analysis of lung transplantation data from January 23, 2020, to March 23, 2020 (2020 cohort), compared to the same period in 2019.
- Implementation of pre- and post-transplant management strategies to prevent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
Main Results:
- Twenty-eight lung transplants were performed, including five for patients with COVID-19-related acute respiratory distress syndrome.
- The 2020 cohort saw more urgent cases, shorter pre-transplant admissions, and earlier mobilization compared to 2019.
- Optimized organ transport logistics and recipient transfer protocols reduced SARS-CoV-2 exposure risks.
- The 90-day survival rate was 85.7% in 2020, with 60% survival in critically ill COVID-19 patients.
Conclusions:
- Lung transplantation and donation can be conducted safely during the COVID-19 pandemic through coordinated efforts.
- Medical resource sharing and staff protection, based on infection risk stratification, are crucial.
- Transplantation outcomes were not compromised, and it can serve as salvage therapy for critical COVID-19 patients.
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.
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