Northwestern Medicine reports positive outcomes in COVID-19 patients who underwent lung transplants

Study compares the first 30 consecutive COVID-19 lung transplant patients with 72 patients transplanted for non-COVID lung problems during the pandemic

For many COVID-19 patients with irrecoverable lung damage, transplantation is the only option for survival. However, there is limited information about the long-term outcomes of these patients, including postoperative complications, hospital length of stay and survival. A new study published in the Journal of the American Medical Association (JAMA) shows positive outcomes in the first 30 consecutive COVID-19 patients who underwent a lung transplant at Northwestern Medicine in Chicago. The outcomes for Northwestern Medicine COVID-19 lung transplant patients are validated by a concurrent paper in New England Journal of Medicine (NEJM) which reports national outcomes at experienced transplant centers.

Among the 102 consecutive lung transplant recipients at Northwestern Medicine from January 21, 2020, to September 30, 2021, 30 patients were transplanted due to COVID-19 and 72 patients were transplanted due to chronic end-stage lung disease including cystic fibrosis, pulmonary hypertension, idiopathic pulmonary fibrosis and chronic obstructive pulmonary disease. The JAMA study found:

COVID-19 PATIENTS	NON-COVID PATIENTS
30 patients were transplanted	72 patients were transplanted
17 men, 13 women	40 men, 32 women
Median age: 53	Median age: 62
Waitlist time: 11.5 days	Waitlist time: 15 days
ECMO was used in 57% of patients	ECMO was used in 1% of patients
During transplant, patients received a median of 6.5 units of packed red blood cells	During transplant, patients received a median of 0 units of packed red blood cells
Median operation time was 8.5 hours	Median operation time was 7.4 hours
Post-transplant median duration of hospitalization was 28.5 days	Post-transplant median duration of hospitalization was 16 days
0% developed lung rejection	12% developed lung rejection
100% of patients were alive at the time the JAMA article was written; current mortality remains above 90%	At follow-up after transplant (488 days median), 83% of patients were alive

“This study proves lung transplantation is highly effective and successful in critically-ill COVID-19 patients. We were especially surprised to find that patients with COVID-19 did not develop rejection of the lungs after transplant,” said Ankit Bharat, MD, chief of thoracic surgery at Northwestern Medicine and executive director of the Canning Thoracic Institute. “We hope lung transplantation will become a standard treatment of care when all other medical therapies fail to achieve lung recovery and get the patients off the ventilator and extracorporeal membrane oxygenation (ECMO), a life support machine that does the work of the heart and lungs. We also hope patients aren’t declined access to this lifesaving intervention due to insurance denials.”

“As shown in the study, COVID-19 lung transplant procedures are much more difficult and require more resources. These procedures are only going to be successful when done at select transplant centers with high levels of experience and necessary resources,” said Scott Budinger, MD, chief of pulmonary and critical care medicine at Northwestern Medicine and medical director of the Canning Thoracic Institute. “While these are lifesaving procedures, they carry substantial risk. Patients need to take medications for the rest of their lives and despite that, they will eventually reject their lungs. Transplant centers should be selective in who they consider for COVID-19 lung transplant procedures, and patients should seek a second opinion when declined for transplant because not all centers have the expertise to perform them.”

In June 2020, Northwestern Medicine surgeons performed the first lung transplant on a COVID-19 patient in the United States. To date, 40 COVID-19 patients have received lung transplants at Northwestern Medicine.

View the JAMA study: https://bit.ly/32HcBCz.
View the NEJM study: https://bit.ly/3raWzu4.