Outcomes of Lung Transplant Using COVID-19 Positive Donors

Purpose: Lung transplant remains the gold standard for end-stage lung disease patients. Because COVID-19 is known to affect the respiratory tract, the usability of COVID-19-positive donor lungs has been questioned. There are reports of using COVID-positive donor lungs, but the data is limited on their overall outcome.

Methods: We used the United Network for Organ Sharing (UNOS) thoracic transplantation database to identify individuals who have undergone lung transplantation between 2020 and 2022. The patients were classified based on the COVID-19 infection status of the donor determined by antigen or PCR test: no COVID infection, acute (tested positive within 4 days of donation), and subacute (tested positive within 4 to 21 days). Non-parametric tests (Kruskal-Wallis for continuous variables and chi-square for categorical variables) were used to evaluate differences in baseline recipient and donor characteristics between the study groups.

Results: Of the 8365 recipients, 73 received lungs from acute COVID patients and 36 from subacute COVID patients. The recipient characteristics were similar across the three groups except for their etiology pre-transplant. The donor groups were also similar across the different COVID statuses, including abnormal chest X-ray (p=0.85), use of ECMO (p=0.12), and being on a ventilator (0.48). Immediate post-operative outcomes did not differ between recipients with donors from COVID negative patients and those with acute or subacute COVID infection. The use of ECMO within 72 hours (p=0.34) and mechanical ventilation after five days (p=0.80) did not differ among recipients. The incidence of primary graft dysfunction was also comparable among those who received lungs from COVID negative donors and those with COVID infection (no COVID 1%, acute COVID 2%, subacute COVID 0%, p=0.14). There was no difference in the 90-day survival (p=0.63). Furthermore, there was no difference in mortality after one year post-transplantation (p=0.63).

Conclusion: There is no difference in the immediate outcomes or survival between recipients with lungs from COVID negative and COVID positive donors. Though a small subset of the population, using lungs from COVID positive donors can be used with caution. Long-term follow-up is still needed to evaluate the usability of COVID-positive lungs for transplantation.

Identify the source of the funding for this research project: University of Louisville, Department of Cartiothoracic Surgery