A Matched Survival Analysis of Lung Transplant Recipients with Covid-19-related Respiratory Failure

Kyle Freischlag; Thomas J Lynch; Vitaly Ievlev; Caitlyn Gries; John C Keech; Evgeny V Arshava; Tahuanty Pena; Julia A Klesney-Tait; Kalpaj R Parekh

doi:10.1016/j.athoracsur.2022.09.039

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A Matched Survival Analysis of Lung Transplant Recipients with Covid-19-related Respiratory Failure

Journal article

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A Matched Survival Analysis of Lung Transplant Recipients with Covid-19-related Respiratory Failure

Kyle Freischlag, Thomas J Lynch, Vitaly Ievlev, Caitlyn Gries, John C Keech, Evgeny V Arshava, Tahuanty Pena, Julia A Klesney-Tait and Kalpaj R Parekh

The annals of thoracic surgery, Vol.116(4), pp.819-828

10/2023

DOI: 10.1016/j.athoracsur.2022.09.039

PMCID: PMC9549709

PMID: 36228676

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https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9549709View

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Abstract

BACKGROUND Lung transplantation is an acceptable and potentially life-saving treatment option for Covid-19-induced acute respiratory distress syndrome and pulmonary fibrosis. The objective of this study is to determine whether recipients of lung transplantation (LT) for Covid-19-related lung disease have comparable outcomes to other recipients with a similar level of lung dysfunction. METHODS The Organ Procurement and Transplant Network database was queried for adult LT candidates between 2006 and 2021. Recipients with Covid-19-related respiratory failure were matched 1:2 using a nearest neighbor algorithm. Kaplan-Meier methods with log-rank tests were used to compare long-term survival. A proportional hazards model was used to calculate risk-adjusted mortality. RESULTS 37,333 LT candidates from all causes were compared to 334 candidates from Covid-19-related respiratory failure. Covid-19 recipients were more likely to be younger (50 vs. 57 years, P<0.001), male (79% vs. 60%, P<0.001), require extracorporeal membrane oxygenation (ECMO) (56.3% vs. 4.0%, P<0.001), and have worse lung function (lung allocation score 82.4 vs 47.8, P<0.001) at transplantation. Subsequently, 227 Covid-19 recipients were matched with 454 controls. Patients transplanted for Covid-19 had similar rates of mechanical ventilation, ECMO, postoperative complications, and functional status at discharge compared with controls. There was no difference in overall survival or risk-adjusted mortality from Covid-19 (hazard ratio 0,82, 95% confidence interval 0.45-1.53, P=0.54). CONCLUSIONS Six-month survival for recipients of LT for Covid-19-related respiratory failure was comparable to that of other lung transplantation recipients.

Details

Title: Subtitle: A Matched Survival Analysis of Lung Transplant Recipients with Covid-19-related Respiratory Failure
Creators: Kyle Freischlag
Thomas J Lynch
Vitaly Ievlev
Caitlyn Gries
John C Keech
Evgeny V Arshava
Tahuanty Pena
Julia A Klesney-Tait
Kalpaj R Parekh
Resource Type: Journal article
Publication Details: The annals of thoracic surgery, Vol.116(4), pp.819-828
DOI: 10.1016/j.athoracsur.2022.09.039
PMID: 36228676
PMCID: PMC9549709
NLM abbreviation: Ann Thorac Surg
ISSN: 0003-4975
eISSN: 1552-6259
Grant note: DOI: 10.13039/100000002, name: NIH
Language: English
Electronic publication date: 10/10/2022
Date published: 10/2023
Academic Unit: Pulmonary, Critical Care, and Occupational Medicine; Anatomy and Cell Biology; Stead Family Department of Pediatrics; Cardiothoracic Surgery; Internal Medicine
Record Identifier: 9984306059902771

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