New data on COVID-19 lung transplants

Date:
January 26, 2022
Source:
Cedars-Sinai Medical Center
Summary:
A new analysis of lung transplantations performed nationally in
the U.S.

shows significant help for patients with severe, irreversible lung
damage from COVID-19.



FULL STORY ==========================================================================
A Smidt Heart Institute analysis of lung transplantations performed
nationally shows significant help for patients with severe, irreversible
lung damage from COVID-19.


==========================================================================
The analysis of more than 3,000 lung transplants in the U.S. between
Aug. 1, 2020, and Sept. 30, 2021, showed that during the pandemic,
7% of the nation's lung transplants were performed to treat severe, irreversible lung damage caused by COVID-19. More than half of these
patients needed ventilators or extracorporeal membrane oxygenation,
or ECMO, before their transplant.

"Our experience treating COVID-19 has shown us that ECMO can be used in carefully selected patients, either as a bridge to lung transplantation,
or to allow a patient's own lungs to heal," said Joanna Chikwe, MD,
founding chair of the Department of Cardiac Surgery in the Smidt Heart Institute at Cedars-Sinai, the Irina and George Schaeffer Distinguished
Chair in Cardiac Surgery, and corresponding author of the data published
in The New England Journal of Medicine (NEJM). "Most of these COVID-19
patients would have been considered too ill to transplant a few years ago,
and the surprising finding of our research was how well they did after
lung transplantation." While on ECMO, a patient's blood is pumped out
of their body, put through an artificial lung, then pumped back into the patient's body. The machine - - similar to a heart-lung bypass machine --
has been around for several decades, although its use for lung failure
has increased significantly in the past decade.

In the past, ECMO has been widely considered a "Hail Mary pass"
by experts.

However, the technology has been employed so often during the global
pandemic that Cedars-Sinai physicians have learned new, effective ways
to utilize the machine and save lives.

Data published in NEJMwas collected from the United Network for Organ
Sharing (UNOS), the nonprofit organization that manages the nation's
organ transplant system. Results from 3,039 lung transplantations show:
* The average age of COVID-19 lung transplant patients was 52.

* 21% of COVID-19 lung transplant patients were female.

* 36.6% of COVID-19 lung transplant patients were Hispanic.

* Among the 214 COVID-19 lung transplants, the three-month survival
was
95.6%.

* Of the 214 COVID-19 lung transplants, 140 patients had COVID-19
acute
respiratory distress syndrome, and 74 patients had COVID-19
pulmonary fibrosis.

"Acute respiratory distress syndrome involves an acute inflammation of
the lungs, resulting in decreased ability for the lungs to oxygenate
and ventilate," said Amy Roach, MD, a general surgery resident and Nagel Research Fellowin the Department of Cardiac Surgery in the Smidt Heart Institute and first author of the published data. "In some patients
this progresses to COVID- 19 pulmonary fibrosis, which causes scarring
in the lung and is generally irreversible." Throughout the pandemic,
Smidt Heart Institute physicians and surgeons have learned how best to
treat patients with ECMO.

"Now we know we must mobilize patients and reduce sedatives, whenever possible," said Dominick Megna, MD, surgical director of the Lung
Transplant Program, assistant professor of Cardiac Surgery and an
author on the study. "We also have a deeper understanding of how long
an individual patient can safely remain on ECMO." Between July 2020 and
June 30, 2021, Cedars-Sinai provided more than 30,000 hours of ECMO care
to patients. Of those 30,000 hours, 21,000 hours were for patients with
severe lung disease due to COVID-19.

"Our analysis suggests lung transplants may be a safe option
for select patients with the most severe, irreversible lung
damage from COVID-19," said Reinaldo Rampolla, MD, medical
director of the Lung Transplant Program at Cedars-Sinai and
one of the authors. "However, our hope is that no one has to
go through ECMO or lung transplant because of COVID-19. The best
protection we have against severe, aggressive disease is vaccination." ========================================================================== Story Source: Materials provided by Cedars-Sinai_Medical_Center. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Amy Roach, Joanna Chikwe, Pedro Catarino, Reinaldo Rampolla, Paul W.

Noble, Dominick Megna, Qiudong Chen, Dominic Emerson, Natalia
Egorova, Shaf Keshavjee, James K. Kirklin. Lung Transplantation
for Covid-19- Related Respiratory Failure in the United States. New
England Journal of Medicine, 2022; DOI: 10.1056/NEJMc2117024 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/01/220126170604.htm

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