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Northwestern Medicine Leads Global Study Providing Guidance for Lung Transplantation in Critically Ill Patients with COVID-19

Includes the first 12 consecutive double-lung transplants performed on COVID-19 patients in the United States, Italy, Austria and India

For many patients with irrecoverable lung damage due to COVID-19, lung transplantation is the only option for survival. However, there are clinical concerns about its technical feasibility as well as its success in critically ill patients with COVID-19. A new global study led by Northwestern Medicine researchers and published in The Lancet Respiratory Medicine provides guidelines for successfully performing the procedure in carefully selected patients, with excellent post-transplant outcomes. The study includes the first 12 consecutive double-lung transplants performed on COVID-19 patients in the United States, Italy, Austria and India, from May to September 2020.

“Every day we are approached by centers across the globe asking for guidance on how to utilize this life-saving procedure. In an effort to show the reproducibility of lung transplants for COVID-19 patients and develop thoughtful criteria, we formed a multinational COVID-19 lung transplant consortium to study the near-term outcomes following lung transplantation for severe COVID-19,” explains Ankit Bharat, MD, chief of thoracic surgery and surgical director of the Northwestern Medicine Lung Transplant Program, who led the study. “Our goal was to share our findings from the first consecutive transplants performed in multiple nations and provide thoughtful guidelines that balance timely transplant referral before critically ill patients die, against premature consideration of lung transplantation, with the risks that entails.”

Of the 12 patients who participated in the study:

- Nine male patients, three female patients
- Average age was 48
- Eight patients received transplants in the United States (four from Northwestern Medicine, three from UF Health, one from St. Joseph’s Norton Thoracic Institute)
- Two patients in Italy
- One patient in Austria
- One patient in India

Study results showed:

- The surgical procedures were extremely difficult due to significant scarring of the lungs and there was an increased need for blood transfusions during transplantation.
- Post-operative complications included temporary kidney failure and blood collection between the chest wall and lungs, which required re-operation.
- Despite complications, the 30-day survival for study participants was 100 percent.
- After a median follow up of 80 days, only one patient suffering from critical illness neuropathy prior to transplant had died while the other 11 patients had either recovered or were following a satisfactory path to recovery.
- There was no recurrence of COVID-19 in any of the recipients.

When considering lung transplantation for critically ill COVID-19 patients, the study recommends:

- A multidisciplinary approach to decision-making
o All the centers included lung transplant surgeons, pulmonologists, intensivists and infectious disease experts. The surgeons in all centers (except one in India) were dedicated thoracic surgeons with a focus on non-cardiac surgery. Both transplant and non-transplant pulmonologists were included in the decision-making.
- Determination of irreversibility
o All the patients included in the study were deemed to be unrecoverable, and without the possibility of lung transplantation, care would have been withdrawn at the respective centers. Hence, lung transplantation was considered as the last resort after weeks or months had elapsed since the onset of their illness. Determination of irreversibility was made based on a multidisciplinary clinical evaluation and confirmed with the pathological examination of the explanted native lungs.

“Lung transplant is a viable treatment option for select patients with severe COVID-19,” says Scott Budinger, MD, chief of pulmonary and critical care medicine at Northwestern Medicine. “In experienced transplant centers with the necessary skills, post-transplant outcomes in these patients can approach those of non-COVID-19 recipients.”

In June 2020, Northwestern Medicine surgeons performed the first known double-lung transplant on a COVID-19 patient in the United States. To date, 15 COVID-19 patients have received double-lung transplants at Northwestern Medicine – the most performed at any health system in the world.

A previous Northwestern Medicine study published in Science Translational Medicine discovered that COVID-19 causes permanent damage and severe scarring to the lungs, mimicking that observed in patients with pulmonary fibrosis, resulting in the need for a lung transplant.

For more information, visit nm.org.