Lung transplantation: challenges in the COVID-19 era, a review of the literature

Abstract

: The severe acute respiratory syndrome coronavirus 2 pandemic poses unique challenges for lung transplant recipients. The optimal management of these patients is not known and the risk of transmission of the SARS-CoV-2 during lung transplantation is a major concern. Clear guidelines for selection of lung transplant candidates due to chronic pulmonary disease due to COVID-19 are urgently needed. The objective of this study is to review the available evidence on the diagnosis and treatment of the coronavirus disease 2019 in lung transplant recipients, as well as current recommendations regarding the screening of potential organ donors and recipients and the implementation of the COVID-19 vaccine in patients both on the waitlist and after lung transplantation. We performed an electronic search of the literature in the PubMed, MedRxiv COVID-19 SARS-Cov-2, LitCovid-NCBI-NLM-NIH, and Medline databases, From December 2019 to January 22, 2021. The following keywords with and without Boolean operators were used: “covid-19”, “SARS-CoV-2” in combination with “lung transplantation”, “solid organ transplant”, and “immunosuppression”. Articles in the English and Spanish languages were extracted. Web sites of the Center for Disease Control (CDC), International Society for Heart & Lung Transplantation, National Institute of Health, Infectious Diseases Society of America (IDSA), and the Federal Drug Administration were reviewed. A total of 168 reports and websites references were used for this review. Lung transplant recipients with COVID-19 are at increased risk for severe illness and death. Management should be similar as the general population but immunosuppression must be adjusted. Lung transplant recipients should receive the COVID-19 vaccine 2 to 3 months after transplantation. Extreme care must be taken to precent transmission of the SARS-CoV-2 during transplantation. The number of patients with post COVID-19 chronic respiratory failure referred for lung transplantation is expected to increase in the near future. There is much to be known regarding the management of lung transplant recipients with COVID-19. Protocols are needed to prevent transmission of the SARS-CoV-2 during transplantation and clear guidelines are needed to define the criteria for lung transplant in patients with residual severe pulmonary disease post COVID-19 infection.