Lung transplantation for COVID-2019 respiratory failure in the United States: Outcomes 1-year posttransplant and the impact of preoperative extracorporeal membrane oxygenation support

Objective: Patients with end-stage respiratory failure after severe coronavirus dis-ease 2019 (COVID-19) infection may benefit from lung transplant; however, data on transplant outcomes and the impact of prolonged circulatory support before trans-plant in these patients are limited.Methods: We assessed survival, postoperative complications, and the impact of pretransplant extracorporeal membrane oxygenation (ECMO) in patients undergo-ing lung transplant in the United States from August 2020 through March 2022 us-ing records validated by United Network for Organ Sharing experts and extracted from the United Network for Organ Sharing database.Results: In 305 patients with COVID-19-related respiratory failure and validated data, survival for up to 1-year posttransplant did not differ between 188 patients with COVID-19-related acute respiratory distress syndrome and 117 patients with post-COVID-19 pulmonary fibrosis (P = .8). Pretransplant ECMO support (median 66 days) was required in 191 patients (63%), and venovenous ECMO was used in 91.2% of patients. One-, 6-, and 12-month survival was not significantly different be-tween patients requiring ECMO and patients without ECMO (95.8% vs 99.1% , 93.1% vs 96.4%, 84.8% vs 90.9%, P = .2) In addition, 1-year survival was similar in recipients requiring ECMO for COVID-19 lung failure and recipients requiring ECMO for non-COVID-19 restrictive lung failure (84.8% vs 78.0%, P = .1).Conclusions: These findings suggest that lung transplant in patients with COVID-19 respiratory failure yields acceptable 1-year outcomes. Despite an often more com-plex postoperative course, prolonged ECMO pretransplant in well-selected patients was associated with adequate clinical and functional status. (J Thorac Cardiovasc Surg 2024;167:384-95)