Lung transplantation is successful for patients with COVID-19-associated acute respiratory distress syndrome (ARDS), with high survival, according to a study published online Jan. 27 in the Journal of the American Medical Association.

Chitaru Kurihara, MD, from Northwestern University in Chicago, and colleagues conducted a retrospective case series of 102 patients who underwent a lung transplant between Jan. 21, 2020, and Sept. 30, 2021, including 30 patients with COVID-19-associated ARDS.

The researchers found that the median lung allocation scores were 85.8 versus 46.7 for lung transplant recipients with COVID-19 versus those without COVID-19; median time on the lung transplant waitlist was 11.5 versus 15 days, and 56.7 and 1.4%, respectively, used preoperative venovenous extracorporeal membrane oxygenation (ECMO).

Patients with COVID-19-associated ARDS received transfusion of a median 6.5 units of packed red blood cells during transplant versus none for those without COVID-19; intraoperative venoarterial ECMO was used by 96.7 and 62.5%, respectively, and the median operative time was 8.5 versus 7.4 hours, respectively.

The rates of primary graft dysfunction within 72 hours were 70 versus 20.8% postoperatively for the COVID-19 cohort versus those without COVID-19; the median time receiving invasive mechanical ventilation was 6.5 versus 2.0 days, and 13.3 and 5.5%, respectively, needed permanent hemodialysis.

Antibody-mediated rejection was demonstrated by none of those with COVID-19-associated ARDS versus 12.5% of those without COVID-19. At follow-up, all COVID-19-associated ARDS lung transplant recipients were alive compared with 83% in the non-COVID-19 cohort.

"Due to the inherent uncertainty in prognosis, the progress of each patient needs to be determined longitudinally over time," the authors write.