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D'Cunha M, Jenkins JA, Wilson R, Farina JM, Omar A, Langlais B, Benz C, D'Cunha J, Reck Dos Santos PA. Lung Transplantation in the United States for COVID-19 Related Lung Disease During the Pandemic. Lung 2024:10.1007/s00408-024-00724-z. [PMID: 38937286 DOI: 10.1007/s00408-024-00724-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024]
Abstract
PURPOSE Lung transplantation (LTx) is a potential intervention for end-stage COVID-19 lung disease. Current literature is sparse regarding the outcomes of LTx for COVID-19 related acute respiratory distress syndrome (ARDS) and pulmonary fibrosis (PF). This study aims to characterize outcomes and patterns of LTx for COVID-19 related lung disease throughout the pandemic. METHODS Patients who underwent LTx during the pandemic for COVID-19 related lung disease were retrospectively identified using the UNOS registry. Demographics, as well as outcomes measures and nationwide patterns of care were collected and analyzed. RESULTS A total of 510 adult cases of LTx for COVID-19 (259 ARDS, 251 PF) were compared to 4,031 without COVID-19 (3,994 PF, 37 ARDS). Patients who received LTx for COVID-19 ARDS did not differ in 2-year survival when compared to those with COVID-19 PF (81.9% vs 77.2%, p = 0.4428). Compared to non-COVID-19 etiologies, COVID-19 ARDS patients had higher rates of stroke (2.3% vs 0%, p = 0.0005), lower rates of graft failure (12.8% vs 36.1%, p = 0.0003) and post-transplant ECMO (29.6% vs 41.7%, p = 0.0002), and improved 2-year survival following LTx (81.9% vs 61.7%, p = 0.0064). No difference in 2-year survival following LTx was observed between patients with COVID-19 and non-COVID-19 PF (77.2% vs 71.8%, p = 0.34). Rates of LTx spiked with variant emergence and declined with rounds of vaccination. CONCLUSION Our results are consistent with early reports of survival outcomes following LTx for COVID-19 ARDS and PF while providing an increased layer of granularity. LTx may be considered as a safe and effective intervention for COVID-19 lung disease.
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Affiliation(s)
- Mikayla D'Cunha
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - J Asher Jenkins
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Renita Wilson
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Juan Maria Farina
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Ashraf Omar
- Division of Pulmonology and Critical Care, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Blake Langlais
- Division of Clinical Trials and Biostatistics, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Cecilia Benz
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
| | - Jonathan D'Cunha
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, 85054, USA
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Saleem F, Liang H, Martin AK. Year in Review 2023: Noteworthy Literature in Cardiothoracic Transplantation. Semin Cardiothorac Vasc Anesth 2024; 28:106-112. [PMID: 38548478 DOI: 10.1177/10892532241242973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
This review highlights key studies examining perioperative management of cardiothoracic transplantation published in 2023. Articles were manually screened after searching Scopus, PubMed, and Google Scholar databases for manuscripts related to cardiothoracic transplantation, which yielded 343 papers with 15 qualitatively selected as the most salient for readers. Overarching themes include differences in outcomes across the various etiologies of end-stage lung disease, novel developments to expand the donor pool, and multi-organ transplantation.
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Affiliation(s)
- Faiz Saleem
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Hong Liang
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL, USA
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Krause M, Tzeng E, Kertai MD, Abrams BA. A Year of Changes: The End of the Pandemic Marks the Beginning of New Priorities. Semin Cardiothorac Vasc Anesth 2024; 28:61-65. [PMID: 38730539 DOI: 10.1177/10892532241255427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2024]
Affiliation(s)
- Martin Krause
- Department of Anesthesiology, University of California San Diego, San Diego, CA, USA
| | - Eric Tzeng
- Department of Anesthesiology, University of California San Diego, San Diego, CA, USA
| | - Miklos D Kertai
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Benjamin A Abrams
- Department of Anesthesiology, University of Colorado, Aurora, CO, USA
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Clancy MJ, Tevald MA, Adler J, Butler K, Courtwright AM, Diamond JM, Crespo MM, Bermudez CA. Reevaluating Rehabilitation Practice for Patients Who Were Critically Ill After COVID-19 Infection: An Administrative Case Report. Phys Ther 2024; 104:pzad175. [PMID: 38109784 DOI: 10.1093/ptj/pzad175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 08/28/2023] [Accepted: 10/24/2023] [Indexed: 12/20/2023]
Abstract
OBJECTIVE The goal of this case report is to describe the process, challenges, and opportunities of implementing rehabilitation for individuals who were critically ill and required both mechanical ventilation (MV) and extracorporeal membrane oxygenation (ECMO) support following a coronavirus 2019 (COVID-19) infection in an academic medical center. METHODS This administrative case report is set in a heart and vascular intensive care unit, a 35-bed critical care unit that provides services for patients with various complex cardiovascular surgical interventions, including transplantation. Patients were admitted to the heart and vascular intensive care unit with either COVID-19 acute respiratory distress syndrome or pulmonary fibrosis for consideration of bilateral orthotropic lung transplantation. The authors describe the process of establishing rehabilitation criteria for patients who, by previously established guidelines, would be considered too ill to engage in rehabilitation. RESULTS The rehabilitation team, in coordination with an interprofessional team of critical care providers including physicians, respiratory care providers, perfusionists, and registered nurses, collaborated to implement a rehabilitation program for patients with critical COVID-19 being considered for bilateral orthotropic lung transplantation. This was accomplished by (1) reviewing previously published guidelines and practices; (2) developing an interdisciplinary framework for the consideration of rehabilitation treatment; and (3) implementing the framework for patients in our heart and vascular intensive care unit. CONCLUSION In response to the growing volume of patients admitted with critical COVID-19, the team initiated and developed an interprofessional framework and successfully provided rehabilitation services to patients who were critically ill. While resource-intensive, the process demonstrates that rehabilitation can be implemented on a case-by-case basis for select patients receiving extracorporeal membrane oxygenation and MV, who would previously have been considered too critically ill for rehabilitation services. IMPACT Rehabilitating patients with end-stage pulmonary disease on extracorporeal membrane oxygenation and MV support is challenging but feasible with appropriate interprofessional collaboration and knowledge sharing.
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Affiliation(s)
- Malachy J Clancy
- Department of Occupational Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Michael A Tevald
- Department of Physical Therapy, Arcadia University, Glenside, Pennsylvania, USA
| | - Joe Adler
- Good Shepherd Penn Partners, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Kelly Butler
- Good Shepherd Penn Partners, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew M Courtwright
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joshua M Diamond
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Maria M Crespo
- Pulmonary, Allergy, and Critical Care Division, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Christian A Bermudez
- Division of Cardiac Surgery, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Endo T, Fox MP. How Old Is Too Old? Bridging the Gap in Lung Transplant Outcomes. ASAIO J 2024; 70:239-240. [PMID: 38411926 DOI: 10.1097/mat.0000000000002165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Affiliation(s)
- Toyokazu Endo
- From the Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Louisville, Kentucky
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Marshall M, Diamond J, Goldberg H, Courtwright A. The impact of high volumes of COVID-related lung transplant on waitlist mortality for non-COVID candidates in the United States. Clin Transplant 2024; 38:e15250. [PMID: 38369820 DOI: 10.1111/ctr.15250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/29/2023] [Accepted: 01/18/2024] [Indexed: 02/20/2024]
Abstract
Some patients with coronavirus disease 19 (COVID) develop serious, irreversible lung disease, including acute respiratory distress syndrome or pulmonary fibrosis. For select candidates, lung transplant is the only option to improve quality and length of life. Because of the severity of end-stage COVID-related lung disease, these candidates receive high allocation priority in the United States, including higher priority than many patients without COVID-related lung disease. This study assessed whether transplant centers with a large volume of COVID-related lung transplants experienced an increase in waitlist mortality for non-COVID transplant candidates. Nineteen centers were included as high-volume programs, defined as being in the top third of centers who transplanted COVID patients. Of the 2867 non-COVID patients waitlisted at these centers, there was no significant difference in waitlist mortalities of non-COVID transplant candidates between the pre-COVID transplant era (January 2018-February 2020) and during the period of high COVID transplant volume (March 2020-October 2022) (subhazard ratio: .92 [95% CI = .81-1.05], p = .22). Among high volume centers, the decision to transplant and to prioritize patients with COVID-related lung disease did not significantly impact the waitlist mortality of other candidates.
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Affiliation(s)
- Maxwell Marshall
- Department of Medical Ethics & Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Joshua Diamond
- Division of Pulmonary and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Hilary Goldberg
- Division of Pulmonary and Critical Care, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrew Courtwright
- Division of Pulmonary and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Hunt ML, Crespo MM, Richards TJ, Bermudez F, Courtwright A, Usman A, Spelde AE, Diamond J, Patel N, Cantu E, Christie J, Clausen E, Cevasco M, Ahya V, Bermudez CA. Lung transplant outcomes after acute respiratory distress syndrome requiring extracorporeal life support: Lessons from the COVID-19 pandemic. J Thorac Cardiovasc Surg 2024:S0022-5223(24)00010-2. [PMID: 38199292 DOI: 10.1016/j.jtcvs.2023.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 11/08/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVE Lung transplant for acute respiratory distress syndrome in patients supported with extracorporeal membrane oxygenation was rare before 2020, but was rapidly adopted to rescue patients with COVID-19 with lung failure. This study aims to compare the outcomes of patients who underwent lung transplant for COVID-associated acute respiratory distress syndrome and non-COVID acute respiratory distress syndrome, and to assess the impact of type and duration of extracorporeal membrane oxygenation support on survival. METHODS Using the United Network for Organ Sharing database, we identified 311 patients with acute respiratory distress syndrome who underwent lung transplant from 2007 to 2022 and performed a retrospective analysis of the patients who required extracorporeal membrane oxygenation preoperatively, stratified by COVID-associated acute respiratory distress syndrome and non-COVID acute respiratory distress syndrome listing diagnoses. The primary outcome was 1-year survival. Secondary outcomes included the effect of type and duration of extracorporeal membrane oxygenation on survival. RESULTS During the study period, 236 patients with acute respiratory distress syndrome and preoperative extracorporeal membrane oxygenation underwent lung transplant; 181 patients had a listing diagnosis of COVID-associated acute respiratory distress syndrome (77%), and 55 patients had a listing diagnosis of non-COVID acute respiratory distress syndrome (23%). Patients with COVID-associated acute respiratory distress syndrome were older, were more likely to be female, had higher body mass index, and spent longer on the waitlist (all P < .02) than patients with non-COVID acute respiratory distress syndrome. The 2 groups had similar 1-year survival (85.8% vs 81.1%, P = .2) with no differences in postoperative complications. Patients with COVID-associated acute respiratory distress syndrome required longer times on extracorporeal membrane oxygenation pretransplant (P = .02), but duration of extracorporeal membrane oxygenation support was not a predictor of 1-year survival (P = .2). CONCLUSIONS Despite prolonged periods of pretransplant extracorporeal membrane oxygenation support, selected patients with acute respiratory distress syndrome can undergo lung transplant safely with acceptable short-term outcomes. Appropriate selection criteria and long-term implications require further analysis.
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Affiliation(s)
- Mallory L Hunt
- Divison of Cardiac Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Maria M Crespo
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Thomas J Richards
- Divison of Cardiac Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | | | - Andrew Courtwright
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Asad Usman
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pa
| | - Audrey E Spelde
- Department of Anesthesiology and Critical Care, University of Pennsylvania, Philadelphia, Pa
| | - Joshua Diamond
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Namrata Patel
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Edward Cantu
- Divison of Cardiac Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Jason Christie
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Emily Clausen
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Marisa Cevasco
- Divison of Cardiac Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Vivek Ahya
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pa
| | - Christian A Bermudez
- Divison of Cardiac Surgery, Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pa.
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