Lung transplantation and coronavirus disease 2019 (COVID-19): a roadmap for the enduring pandemic

Abstract

Due to the ongoing coronavirus disease 2019 (COVID-19) pandemic, organ transplant specialists remain uncertain of directions and goals before and after organ replacement therapy (1). Reports of COVID-19 outcomes in lung transplant recipients have been limited, comprising a small number of case series without a consistent approach between those infected post-transplant and those who became candidates for a transplant post-infection (2-5). Nonetheless, the pandemic has inspired new roles for lung failure specialists who must care for patients who develop acute respiratory distress syndrome (ARDS) and progressive pulmonary fibrosis due to COVID-19 (6). Specialists who can handle organ replacement therapy including extracorporeal membrane oxygenation (ECMO) and lung transplantation are an integral part of the multidisciplinary care team (2,7). In the midst of the first phase of the pandemic, we offered our insights regarding the direction of lung transplantation during the pandemic as specialists at a high-volume center in a geographical area with high COVID-19 infection rates (8). Herein, we expand our review of outcomes in lung transplant recipients with COVID-19 infections and offer our phased approach as well as insights for lung transplantation for post covid lung failure as the sequelae of COVID-19 infection in light of our large outcomes data for the recipients with positive covid after lung transplantation.