Early Post-transplant Complications and Overall Mortality After COVID Lung Transplant

This study evaluated early complications and overall mortality in lung transplant recipients with COVID-19-related lung damage, compared to those with other indications, to inform preoperative planning and patient management.

A retrospective cohort study was conducted using the Scientific Registry of Transplant Recipients (January 2020-October 2023). Adult recipients transplanted for COVID-19 were identified via diagnosis codes. Multivariate regression adjusted for donor and recipient characteristics was used to compare overall mortality and postoperative complications, including primary graft dysfunction, acute rejection, prolonged intubation, ECMO, tracheostomy, dialysis, stroke, airway dehiscence, in-hospital mortality, and length of stay.

COVID recipients were younger (23.2% versus 59.7% > 60 y, P < 0.001), predominantly male (75.6% versus 59.7%, P < 0.001), and more likely to be in intensive care unit (63.6% versus 14.0%, P < 0.001), on ECMO (51.4% versus 5.7%, P < 0.001), or ventilated (38.8% versus 4.2%, P < 0.001). They had higher lung allocation scores (87.4 versus 41, P = 0.001) and shorter waitlist times (15 versus 34 d, P = 0.001). COVID donor lungs came from younger donors with fewer nonbeating hearts. COVID recipients had lower overall mortality (hazard ratio = 0.61, 95% confidence interval: 0.46 = 0.81, P = 0.01). Mortality risk was higher with age >60 y, preoperative ECMO, donor age ≥55 y, and prolonged ischemia. Tracheostomy risk was higher in COVID recipients (odds ratio = 2.47, P = 0.007), especially with preoperative ventilation, but lower in older recipients. No differences were observed in other complications.

COVID lung transplant recipients experienced lower mortality but greater tracheostomy risk, highlighting the need for individualized perioperative strategies.