Table 3 Patients with COVID-19-related ARDS who are candidates for lung transplantation
The patient should fulfill standard criteria for LTx | Comment |
|---|---|
Age > 65 years | Poor outcomes for older patients |
At least 4–6 weeks to exclude native lung recovery | sufficient time should be allowed for lung recovery |
Radiographic findings correlated with the patient’s clinical course | Extensive honeycombing, cystic changes, reticular opacities, and traction bronchiectasis, > 80% of lung involvement, a right atrium to left atrium ratio > 1, associated with extended period of static respiratory mechanics or ECMO parameters |
Negative SARS-CoV-2 virology status | Mortality after surgical procedures is significantly higher for PCR-positive patients, even in those who are asymptomatic |
Irreversible concomitant organ failure must be absent | In selected cases, multiorgan transplantation can be considered |
The patient should be able to actively participate in physical rehabilitation | Patients able to at least sit out of bed and stand with assistance for them to remain viable transplant candidates |
The patient should be able to provide first-person consent to LTx and transfusion | - Patients need to understand the impact of transplantation on quality of life - Immunosuppression and complications ahead can be psychologically traumatic and sometimes insurmountable |
Antibodies should be carefully evaluated due to the likely history of exposure in the critical illness period leading up to listing | Â |
The patient should have minimal acute comorbidities | Â |
Decisions regarding these patients should be critically re-evaluated on a periodic basis | Early involvement of the lung transplant team is desirable because it permits adequate time to follow these patients longitudinally |
Experience with high-risk transplantation | Referral to a few specialized centers could greatly improve outcomes for patients with COVID-19 who undergo lung transplantation |
Broad donor pool and low waiting list mortality | This factor will maintain fair and equitable donor organ allocation and provide the chance for life-saving organ transplantation to patients who are more likely to survive |