Waiting List For Lung Transplantation Research Articles

Impact of Functional Status at the Time of Transplant on Short-Term Pediatric Lung Transplant Outcomes in the USA.

Poor functional status is associated with pediatric lung transplant (LTx) waitlist mortality. We investigate how pre-transplant functional status affects post-LTx survival. A retrospective analysis was performed using The United Network for Organ Sharing (UNOS) Registry data. Pediatric first-time lung transplant candidates between ages 1 and 18years with reported Lansky Play-Performance Scores (LPPS) at the time of waitlist and/or transplant were included from 2005 and 2021. Functional status by the LPPS scores is defined as severe limitation for LPPS score 10-40, mild limitation for LPPS score 50-70, and normal activity for LPPS score 80-100. Univariate analyses, multivariable Cox regression, and Kaplan-Meier plots were used to assess the impact of functional status on 1-year post-LTx survival. There were 913 and 610 patients at the time of LTx listing and transplant with LPPS scores, respectively. Poor functional status as determined by the LPPS score at the time of LTx, but not at the time of waitlist, was associated with worse 1-year post-LTx outcome (p value 0.0025 vs. 0.071). Multivariable survival analysis using Cox proportional hazards regression identified that a severely limited functional status at the time of LTx was the most profound risk factor for worse 1-year post-LTx survival outcomes when compared to a normal functional status (HR 2.16; 95% CI 1.15-4.07, p value 0.017). Children with severely limited functional status at the time of LTx have worse 1-year post-LTx outcome. It is important to develop strategies to optimize the functional status of children for improved post-LTx outcomes.

Pulmonary hypertension and lung transplantation waitlist outcomes for hypersensitivity pneumonitis

RationaleHypersensitivity pneumonitis is an interstitial lung disease that can progress to pulmonary hypertension which increases mortality. The European Society of Cardiology recently reduced the diagnostic criteria for pre-capillary pulmonary hypertension from mean pulmonary artery pressure ≥25mmHg to ≥20mmHg and pulmonary vascular resistance from ≥3Wu to ≥2Wu. ObjectiveWe investigated the effect of the new criteria on hypersensitivity pneumonitis lung transplantation waitlist outcomes. MethodsWe conducted a retrospective cohort study of the Scientific Registry of Transplant Recipients.1175 hypersensitivity pneumonitis patients listed for lung transplantation were divided into three groups based on the presence of pre-capillary pulmonary hypertension; those with pre-capillary pulmonary hypertension based on old criteria, new criteria, and those without pre-capillary pulmonary hypertension based on either criterion. The individual components of pre-capillary pulmonary hypertension were also assessed with three mean pulmonary artery pressure groups (≤20mmHg, >20mmHg to <25mmHg, ≥25 mmHg) and three pulmonary vascular resistance groups (≤2Wu, >2Wu to <3Wu, ≥3Wu). Survival analysis was performed. Measurements and Main ResultsKaplan-Meier analysis showed a difference in waitlist survival probability among the mean pulmonary artery pressure groups and among the pulmonary vascular resistance groups driven by the most severe groups. Multivariate Cox regression showed no difference between the various pre-capillary pulmonary hypertension groups. Pulmonary vascular resistance ≥3Wu was associated with increased waitlist mortality. ConclusionsThe new thresholds of mean pulmonary artery pressure and pulmonary vascular resistance do not appear to prognosticate waitlist outcomes when combined. PVR ≥3Wu is associated with worse waitlist outcomes and may be useful in prognostication.

Effect of mTOR inhibitors on the mortality and safety of patients with lymphangioleiomyomatosis on the lung transplantation waitlist: A retrospective cohort study

BackgroundAlthough lung transplantation (LTx) is the last resort for patients with end-stage lymphangioleiomyomatosis (LAM), the high waitlist mortality is a source of concern in Japan. Discontinuation of mechanistic target of rapamycin (mTOR) inhibitors prior to LTx is recommended due to the incidence of severe adverse events. Therefore, we hypothesized that mTOR inhibitors may affect the mortality of patients with LAM on the LTx waitlist. MethodsWe retrospectively compared the characteristics of consecutive patients with LAM on the LTx waitlist who were and were not receiving mTOR inhibitors. ResultsTwenty-nine consecutive patients with LAM who listed our center between January 2004 and December 2021 were selected from the database and enrolled in the present study. Seventeen patients (58.6%) were receiving a mTOR inhibitor, sirolimus (treatment group). During a median listing period of 1277 days, 12 patients (41.4%) were hospitalized, six patients (20.7%) died from disease before LTx, and 15 patients underwent LTx. Among the deceased patients, four patients (66.6%) had pneumothoraces. The waitlist mortality in the treatment group was significantly lower than that in the non-treatment group (p = 0.03). Among the six patients who discontinued sirolimus in the treatment group, four patients (66.6%) were hospitalized with respiratory complications after the discontinuation of sirolimus. No mTOR inhibitor-related complications arose in the treatment group undergoing LTx (n = 7), including those on a reduced sirolimus dose. ConclusionsAdministration of an mTOR inhibitor until LTx may decrease waitlist mortality. Due to life-threatening events after discontinuing sirolimus pre-LTx, a reduced dose until LTx is permissible.

(649) - Changes in Lung Transplant Waitlist Outcomes for Primary Pulmonary Hypertension (PPH) After Revision of Lung Allocation System: A UNOS Analysis

(649) - Changes in Lung Transplant Waitlist Outcomes for Primary Pulmonary Hypertension (PPH) After Revision of Lung Allocation System: A UNOS Analysis

Elevated pulmonary vascular resistance is associated with increased lung transplant waitlist mortality among patients with chronic obstructive pulmonary disease and pulmonary hypertension: a retrospective cohort analysis

BackgroundThe latest European Society of Cardiology and European Respiratory Society guidelines have changed the definition of both pre-capillary pulmonary hypertension (PH) and severe PH in chronic lung disease. The clinical significance of these new criteria are unclear among patients with chronic obstructive pulmonary disease (COPD)-PH. We aim to examine the clinical significance of the new PH definitions with regards to lung transplant waitlist mortality amongst patients with COPD-PH.MethodsThis was a retrospective cohort study of adult patients with COPD-PH listed for lung transplantation. Kaplan–Meier survival analyses were performed comparing patients with newly defined pre-capillary PH to those without pre-capillary PH and comparing patients with severe PH, defined as pulmonary vascular resistance (PVR) > 5 WU, to those without severe PH. Both mean pulmonary artery pressure (mPAP) and PVR were analyzed for potential cut-off points associated with increased waitlist mortality. Predictors of waitlist mortality were identified via Cox regression.ResultsAmong 6495 patients with COPD-PH listed for lung transplantation, pre-capillary PH was not associated with increased waitlist mortality (logrank p = 0.43), while severe PH was (logrank p < 0.001). Both severe PH (HR 1.79, 95% CI 1.22–2.60, p = 0.003) and PVR > 3.9 WU (HR 1.49, 95% CI 1.14–1.95, p = 0.004) were independently and significantly associated with increased waitlist mortality.ConclusionsPVR may serve as a strong predictor of lung transplant waitlist mortality among patients with COPD-PH as compared to other pulmonary hemodynamic parameters when predicting transplant waitlist mortality.

Patient management for thoracic organ donor candidates: the lung transplantation team's view.

Despite the increasing demand for lung transplants, donor lungs remain in short supply. Although organ donations have been steadily increasing in Korea, with the utilization rate for donor lungs increasing to 40% in recent years, many potential donor organs remain unused. To match the increasing number of patients on the lung transplant waitlist, it is essential to increase the donor procurement rate through optimal management. Improvements in donor lung management programs can lead to expansion of the donor pool and optimal posttransplant outcomes. This review focuses on basic protocols for the optimal management of donor lungs and summarizes coronavirus disease 2019-related considerations for donor lung evaluation.

Humoral and cellular immune responses after COVID-19 vaccination of lung transplant recipients and patients on the waiting list: a 6-month follow-up.

Data on cellular response and the decay of antibodies and T cells in time are scarce in lung transplant recipients (LTRs). Additionally, the development and durability of humoral and cellular immune responses have not been investigated in patients on the waitlist for lung transplantation (WLs). Here, we report our 6-month follow-up of humoral and cellular immune responses of LTRs and WLs, compared with controls. Humoral responses to two doses of the mRNA-1273 vaccination were assessed by determining spike (S)-specific IgG antibodies and neutralizing antibodies. Cellular responses were investigated by interferon gamma (IFN-γ) release assay (IGRA) and IFN-γ ELISpot assay at 28 days and 6 months after the second vaccination. In LTRs, the level of antibodies and T-cell responses was significantly lower at 28 days after the second vaccination. Also, WLs had lower antibody titers and lower T-cell responses compared with controls. Six months after the second vaccination, all groups showed a decrease in antibody titers and T-cell responses. In WLs, the rate of decline of neutralizing antibodies and T-cell responses was significantly higher than in controls. Our results show that humoral and cellular responses in LTRs, if they develop, decrease at rates comparable with controls. In contrast, the inferior cellular responses and the rapid decay of both humoral and cellular responses in the WL groups imply that WLs may not be protected adequately by two vaccinations and repeat boostering may be necessary to induce protection that lasts beyond the months immediately post-transplantation.

Sarcoidosis lung transplantation waitlist mortality, a national registry database study.

The Lung Allocation Score (LAS) prioritises lung transplantation candidates, balancing waitlist mortality and post-transplant survival. The score groups sarcoidosis candidates based on mean pulmonary artery pressure: those with ≤30 mmHg (sarcoidosis A) are grouped with COPD and those with >30 mmHg (sarcoidosis D) with idiopathic pulmonary fibrosis (IPF). We hypothesise that sarcoidosis candidates have a higher waitlist mortality than other candidates within their LAS grouping. This is a retrospective cohort study of consecutive lung transplantation candidates from the Scientific Registry of Transplant Recipients database from May 2005 to May 2019. We included candidates aged ≥18 years diagnosed with sarcoidosis, COPD or IPF. Univariate, multivariate and survival estimate analyses were performed. We identified 385 sarcoidosis A, 642 sarcoidosis D, 7081 COPD and 10 639 IPF lung transplantation candidates. 17.3% of sarcoidosis D, 14.8% of IPF, 14.3% of sarcoidosis A and 9.8% of COPD candidates died awaiting transplant. Sarcoidosis A was an independent risk factor for waitlist mortality. Sarcoidosis A had a lower waitlist survival probability compared to COPD. Sarcoidosis D had the highest waitlist mortality. IPF candidates had lower waitlist survival probability than sarcoidosis D in the first 60 days after listing. Based on our results, the grouping of candidates with sarcoidosis in allocation systems should be revised to mitigate waitlist mortality disparity.

(1235) Lung Transplant Waitlist Outcomes Before and after 2021 LAS Revision

(1235) Lung Transplant Waitlist Outcomes Before and after 2021 LAS Revision

Lung Transplantation Waitlist Mortality Among Sarcoidosis Patients by Lung Allocation Score Grouping

The Lung Allocation Score (LAS) system was designed to equalize and minimize waitlist mortality among candidiates for lung transplantation. The LAS stratifies sarcoidosis patients by mean pulmonary arterial pressure (mPAP) into group A (mPAP ≤30 mm Hg) and group D (mPAP >30 mm Hg). In this study, we aimed to analyze the effect of diagnostic grouping and patient characteristics on waitlist mortality among sarcoidosis patients. This was a retrospective review of sarcoidosis lung transplantation candidates since LAS implementation in May 2005 through May 2019 in the Scientific Registry of Transplant Recipients database. We compared baseline characteristics, LAS variables, and waitlist outcomes between sarcoidosis groups A and D. We performed Kaplan-Meier survival analysis and multivariable regression to determine associations with waitlist mortality. We identified 1027 sarcoidosis candidates since LAS implementation. Of these, 385 had mPAP ≤30 mm Hg and 642 had mPAP >30 mm Hg. Waitlist mortality was 18% in sarcoidosis group D and 14% in sarcoidosis group A. Kaplan-Meier curve showed lower waitlist survival probability for sarcoidosis group D than group A (log-rank P=.0049). Functional status, oxygen requirement, and sarcoidosis group D were associated with increased waitlist mortality. Cardiac output ≥4 L/min was associated with decreased waitlist mortality. Sarcoidosis group D had lower waitlist survival than group A. Decreased survival appears driven by mPAP; sarcoidosis group D, functional status, oxygen requirement, and cardiac output had significant associations with waitlist mortality. These findings suggest that the current LAS grouping does not adequately reflect the risk for waitlist mortality among sarcoidosis group D patients.

Ambulatory oxygen therapy in lung transplantation candidates with idiopathic pulmonary fibrosis referred for pulmonary rehabilitation.

To determine independent factors related to the use of oxygen and the oxygen flow rate in idiopathic pulmonary fibrosis (IPF) patients placed on a lung transplant waitlist and undergoing pulmonary rehabilitation (PR). This was a retrospective quasi-experimental study presenting functional capacity and health-related quality of life (HRQoL) data from lung transplant candidates with IPF referred for PR and receiving ambulatory oxygen therapy. The patients were divided into three groups on the basis of the oxygen flow rate: 0 L/min (the control group), 1-3 L/min, and 4-5 L/min. Data on functional capacity were collected by means of the six-minute walk test, and data on HRQoL were collected by means of the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36), being collected before and after 36 sessions of PR including aerobic and strength exercises. The six-minute walk distance improved in all three groups (0 L/min: Δ 61 m, p < 0.001; 1-3 L/min: Δ 58 m, p = 0.014; and 4-5 L/min: Δ 35 m, p = 0.031). Regarding HRQoL, SF-36 physical functioning domain scores improved in all three groups, and the groups of patients receiving ambulatory oxygen therapy had improvements in other SF-36 domains, including role-physical (1-3 L/min: p = 0.016; 4-5 L/min: p = 0.040), general health (4-5 L/min: p = 0.013), social functioning (1-3 L/min: p = 0.044), and mental health (1-3 L/min: p = 0.046). The use of ambulatory oxygen therapy during PR in lung transplant candidates with IPF and significant hypoxemia on exertion appears to improve functional capacity and HRQoL.

Lung transplant waitlist outcomes among ABO blood groups vary based on disease severity

Blood group O candidates have lower lung transplantation rates despite having the most common blood group. We postulated that waitlist outcomes among these candidates and those with other blood types vary with disease severity and lung allocation score (LAS). We performed a retrospective cohort study of 32,772 waitlist candidates using the United Network of Organ Sharing registry from May 2005 to 2020. After identifying an interaction between blood group and LAS, we evaluated the association between blood group and waitlist outcomes within LAS quartiles using unadjusted and adjusted competing risk models. In the lowest LAS quartile, blood group O had a 20% reduced transplantation rate (SHR: 0.80, 95%CI: 0.75-0.85) and higher waitlist death/removal (1.33, 95%CI: 1.15-1.55) compared with group A. Blood group AB had a 52% higher transplantation rate (SHR: 1.52, 95%CI: 1.34-1.73) in the lowest LAS quartile compared with group A. In the highest LAS quartile, there was no difference in transplantation rates between groups O and A. In contrast, group B had a 19% reduced transplantation rate (SHR, 0.81 95%CI: 0.73-0.89) and AB had a 28% reduced transplantation rate (SHR: 0.72, 95%CI: 0.61-0.86) in the highest LAS quartile. Additionally, groups B and AB had increased risk of waitlist death/removal in the highest LAS quartile compared with A (SHR: 1.27, 95%CI: 1.08-1.48; SHR: 1.31, 95%CI: 1.00-1.72). Waitlist outcomes among ABO blood groups vary depending on illness severity, which is represented by LAS. Blood group O has lower transplantation rates at low LAS while groups B and AB have lower transplantation rates at high LAS.

Predictors of lung transplant waitlist mortality for sarcoidosis

RationaleUnlike in other chronic lung diseases, criteria for lung transplant referral in sarcoidosis is not well-established. Waitlist mortality may offer clues in identifying clinical factors that warrant early referral. We aim to identify predictors for transplant waitlist mortality to improve referral criteria for patients with sarcoidosis. MethodsWe conducted a retrospective analysis of 1034 sarcoidosis patients listed for lung transplantation from May 2005 to May 2019 in the Scientific Registry of Transplant Recipients (SRTR) database. All patients were listed after the establishment of the Lung Allocation Score (LAS). We compared patients who died on the transplant waitlist to those who survived to transplantation. Potential predictors of waitlist mortality were assessed utilizing univariate and multivariate analysis performed via logistic regression modeling. ResultsOf 1034 candidates listed after LAS implementation, 704 were transplanted and 110 died on the waitlist. Significant predictors of waitlist mortality on multivariate analysis include female gender (OR 2.445; 95% CI 1.513–3.951; p = 0.0003) and severe pulmonary hypertension (OR 1.619; 95% CI 1.067–2.457; p = 0.0236). Taller minimum donor height (OR 0.606; 95% CI 0.379–0.969; p = 0.0365) and blood type B (OR 0.524; 95% CI 0.281–0.975 p = 0.0415) were associated with decreased likelihood of death on the waitlist. ConclusionAmong patients with sarcoidosis on the lung transplant waitlist, taller minimum donor height and blood type B were found to be protective factors against death on the waitlist. Female gender and severe pulmonary hypertension have a higher likelihood of death and earlier referral for transplantation in patients with these characteristics should be considered.

147 Lung transplantation waitlist disparities for children with cystic fibrosis

147 Lung transplantation waitlist disparities for children with cystic fibrosis

Effects of Blood Group and ABO Compatibility on Lung Transplant Waitlist and Post-Transplant Outcomes

PurposeBlood group O individuals are universal donors, but O recipients are limited to O donors. This constraint combined with the current lung allocation system places O recipients at a hypothetical disadvantage. This study evaluates waitlist outcomes, post-transplant outcomes, and overall survival from time of listing by blood group.MethodsLung transplant candidates from 2/2015 - 2/2019 were identified from the Scientific Registry of Transplant Recipients. A Fine and Gray model adjusted for OPO region, height, sex, and LAS was used to determine the competing risk for waitlist mortality or transplant by blood group and a model adjusted for LAS at transplant used to determine the competing risk for post-transplant mortality. A Cox proportional hazards regression model utilizing a time-varying covariate of transplant and adjusted for the above was used to determine the adjusted risk from listing to death by blood group. Unadjusted outcomes were visualized using Kaplan-Meir curves.ResultsA total of 9,846 candidates were identified, with 8,181 (83%) receiving a lung transplant and 964 (10%) experiencing waitlist death. Blood group A candidates had higher adjusted access to transplant (sHR 1.23, 1.17-1.29) and lower waitlist mortality (sHR 0.77, CI 0.66-0.89) (Fig 1a). AB candidates had a higher adjusted access to transplant (sHR 1.24, CI 1.1-1.4). There was no difference in the adjusted risk for post-transplant death by blood type (Fig 1b). There was no significant difference in mortality from time of listing across blood groups (Fig 1c) and in graft failure or post-transplant mortality by ABO compatibility.ConclusionTransplant equity varies across blood groups with significant differences in adjusted access to transplant and waitlist mortality by blood group. Despite this, post-transplant survival and survival from the time of listing are similar across blood groups. These results support the need to reconsider allocation schemas to mitigate blood group waitlist inequalities. Blood group O individuals are universal donors, but O recipients are limited to O donors. This constraint combined with the current lung allocation system places O recipients at a hypothetical disadvantage. This study evaluates waitlist outcomes, post-transplant outcomes, and overall survival from time of listing by blood group. Lung transplant candidates from 2/2015 - 2/2019 were identified from the Scientific Registry of Transplant Recipients. A Fine and Gray model adjusted for OPO region, height, sex, and LAS was used to determine the competing risk for waitlist mortality or transplant by blood group and a model adjusted for LAS at transplant used to determine the competing risk for post-transplant mortality. A Cox proportional hazards regression model utilizing a time-varying covariate of transplant and adjusted for the above was used to determine the adjusted risk from listing to death by blood group. Unadjusted outcomes were visualized using Kaplan-Meir curves. A total of 9,846 candidates were identified, with 8,181 (83%) receiving a lung transplant and 964 (10%) experiencing waitlist death. Blood group A candidates had higher adjusted access to transplant (sHR 1.23, 1.17-1.29) and lower waitlist mortality (sHR 0.77, CI 0.66-0.89) (Fig 1a). AB candidates had a higher adjusted access to transplant (sHR 1.24, CI 1.1-1.4). There was no difference in the adjusted risk for post-transplant death by blood type (Fig 1b). There was no significant difference in mortality from time of listing across blood groups (Fig 1c) and in graft failure or post-transplant mortality by ABO compatibility. Transplant equity varies across blood groups with significant differences in adjusted access to transplant and waitlist mortality by blood group. Despite this, post-transplant survival and survival from the time of listing are similar across blood groups. These results support the need to reconsider allocation schemas to mitigate blood group waitlist inequalities.

Survival Benefit of Lung Transplant in Septuagenarians: A United Network of Organ Sharing Database Analysis

<h3>Purpose</h3> The benefit of lung transplant in septuagenarians is questioned on the grounds that recipients must be so highly selected that their baseline survival negates any benefit of transplant. This study evaluated the short-term outcomes and survival benefit of lung transplant in septuagenarians compared to waitlist patients that did not receive a transplant. <h3>Methods</h3> Using the United Network for Organ Sharing database, lung transplant recipients and waitlist candidates from 1991-2021 were analyzed. Dual organ transplant candidates/recipients and those without validated records were excluded. The cohort consisted of 3109 patients, 12.9% (400) were waitlist candidates and 87.1% (2709) were lung transplant recipients all seventy years of age and older. Propensity matching on eleven demographic characteristics, year of waitlist/surgery, and waitlist time produced 384 pairs with correction of baseline differences. Short-term survival was compared with a Cox regression model. Median follow-up of the lung transplants was 2 years (interquartile range (IQR) 0.8-4) versus 0.3 (IQR 0.1-0.6) for waitlist candidates. <h3>Results</h3> Lung transplants in septuagenarians increased from 0.14% (1) in 1991 to 12.2% (193) transplants in 2021, p<0.001. The median age of the unmatched waitlist candidates and recipients was 71 (IQR 70-73), with a listing lung allocation score of 38.7 (IQR 34-48.5) and 37.8 (IQR 34.1-44.8), respectively, all p>0.5. In the unmatched cohort, there was a higher proportion of females in the waitlist group (37.3% (149) vs 25% (677)), p<0.0001. In matched patients, six-month survival was lower in the waitlist group 42% (95% CI 36.4-47.4) versus 91.1% (95% CI 87.6-93.7), p<0.0001 (Figure). <h3>Conclusion</h3> Lung transplant can be offered in septuagenarians with survival benefit in those eligible for lung transplant. These findings may inform the transplant community that selection bias due to age should be reconsidered.

A Simple Scoring System for Lung Transplant Waitlist Mortality Risk Factors

<h3>Purpose</h3> Current lung allocation score (LAS) waitlist mortality prediction models are complex and incorporate correlated predictors. This study identified and evaluated three multidimensional indices of correlated risk factors. This approach could enable more efficient use of risk factor information and improve dynamic models of end-stage lung disease and transplant outcomes. <h3>Methods</h3> We analyzed 2015-2020 data on U.S. lung transplant candidates on the waiting list, obtained from the Scientific Registry for Transplant Recipients (N=13990). We used hierarchical clustering to identify distinct respiratory support groups based on supplemental oxygen device, rate and frequency of use; steroid use and extracorporeal membrane oxygenation. We used confirmatory factor analysis (CFA) to derive indices of i) airway function (forced expiratory volume, forced vital capacity, and partial pressure of carbon dioxide [PCO₂]) and ii) oxygen function (partial pressures of oxygen (PO₂), PO₂/FiO₂ ratio, and mean pulmonary artery pressure). Cox proportional hazards regression was used to characterize relationships between the developed constructs and waitlist mortality (or removal) after adjusting for disease group, age and sex. <h3>Results</h3> Four respiratory support clusters were identified (see the panel labels in the <b>Figure</b>). Contours of predicted 6-month waitlist mortality risk are displayed for a sample 63-year-old patient with idiopathic pulmonary fibrosis in the Figure. The area under the receiver-operating characteristic curve [95% confidence interval] for 1-year predictions from the fitted Cox model was 0.75 [0.71, 0.79], which was marginally lower than that of the full LAS waitlist mortality model (AUC = 0.79 [0.75, 0.83]). <h3>Conclusion</h3> The three developed constructs of respiratory support, oxygen function and airway function distilled information in 11 correlated risk factors for waitlist mortality, facilitating interpretation of risk profiles without adversely impacting model accuracy. <h3>Funding</h3> NIH R01HL15375

Clinical Characteristics and Outcomes of Patients With COVID-19–Associated Acute Respiratory Distress Syndrome Who Underwent Lung Transplant

Lung transplantation is a potentially lifesaving treatment for patients who are critically ill due to COVID-19-associated acute respiratory distress syndrome (ARDS), but there is limited information about the long-term outcome. To report the clinical characteristics and outcomes of patients who had COVID-19-associated ARDS and underwent a lung transplant at a single US hospital. Retrospective case series of 102 consecutive patients who underwent a lung transplant at Northwestern University Medical Center in Chicago, Illinois, between January 21, 2020, and September 30, 2021, including 30 patients who had COVID-19-associated ARDS. The date of final follow-up was November 15, 2021. Lung transplant. Demographic, clinical, laboratory, and treatment data were collected and analyzed. Outcomes of lung transplant, including postoperative complications, intensive care unit and hospital length of stay, and survival, were recorded. Among the 102 lung transplant recipients, 30 patients (median age, 53 years [range, 27 to 62]; 13 women [43%]) had COVID-19-associated ARDS and 72 patients (median age, 62 years [range, 22 to 74]; 32 women [44%]) had chronic end-stage lung disease without COVID-19. For lung transplant recipients with COVID-19 compared with those without COVID-19, the median lung allocation scores were 85.8 vs 46.7, the median time on the lung transplant waitlist was 11.5 vs 15 days, and preoperative venovenous extracorporeal membrane oxygenation (ECMO) was used in 56.7% vs 1.4%, respectively. During transplant, patients who had COVID-19-associated ARDS received transfusion of a median of 6.5 units of packed red blood cells vs 0 in those without COVID-19, 96.7% vs 62.5% underwent intraoperative venoarterial ECMO, and the median operative time was 8.5 vs 7.4 hours, respectively. Postoperatively, the rates of primary graft dysfunction (grades 1 to 3) within 72 hours were 70% in the COVID-19 cohort vs 20.8% in those without COVID-19, the median time receiving invasive mechanical ventilation was 6.5 vs 2.0 days, the median duration of intensive care unit stay was 18 vs 9 days, the median post-lung transplant hospitalization duration was 28.5 vs 16 days, and 13.3% vs 5.5% required permanent hemodialysis, respectively. None of the lung transplant recipients who had COVID-19-associated ARDS demonstrated antibody-mediated rejection compared with 12.5% in those without COVID-19. At follow-up, all 30 lung transplant recipients who had COVID-19-associated ARDS were alive (median follow-up, 351 days [IQR, 176-555] after transplant) vs 60 patients (83%) who were alive in the non-COVID-19 cohort (median follow-up, 488 days [IQR, 368-570] after lung transplant). In this single-center case series of 102 consecutive patients who underwent a lung transplant between January 21, 2020, and September 30, 2021, survival was 100% in the 30 patients who had COVID-19-associated ARDS as of November 15, 2021.

Outcomes of Patients on the Lung Transplantation Waitlist in Korea: A Korean Network for Organ Sharing Data Analysis.

The demand for lung transplants continues to increase in Korea, and donor shortages and waitlist mortality are critical issues. This study aimed to evaluate the factors that affect waitlist outcomes from the time of registration for lung transplantation in Korea. Data were obtained from the Korean Network for Organ Sharing for lung-only registrations between September 7, 2009, and December 31, 2020. Post-registration outcomes were evaluated according to the lung disease category, blood group, and age. Among the 1,671 registered patients, 49.1% had idiopathic pulmonary fibrosis (group C), 37.0% had acute respiratory distress syndrome and other interstitial lung diseases (group D), 7.2% had chronic obstructive pulmonary disease (group A), and 6.6% had primary pulmonary hypertension (group B). Approximately half of the patients (46.1%) were transplanted within 1 year of registration, while 31.8% died without receiving a lung transplant within 1 year of registration. Data from 1,611 patients were used to analyze 1-year post-registration outcomes, which were classified as transplanted (46.1%, n = 743), still awaiting (21.1%, n = 340), removed (0.9%, n = 15), and death on waitlist (31.8%, n = 513). No significant difference was found in the transplantation rate according to the year of registration. However, significant differences occurred between the waitlist mortality rates (P = 0.008) and the still awaiting rates (P = 0.009). The chance of transplantation after listing varies depending on the disease category, blood type, age, and urgency status. Waitlist mortality within 1 year was significantly associated with non-group A disease (hazard ratio [HR], 2.76, P < 0.001), age ≥ 65 years (HR, 1.48, P < 0.001), and status 0 at registration (HR, 2.10, P < 0.001). Waitlist mortality is still higher in Korea than in other countries. Future revisions to the lung allocation system should take into consideration the high waitlist mortality and donor shortages.

Predictors of Lung Transplant Waitlist Mortality for Sarcoidosis

Predictors of Lung Transplant Waitlist Mortality for Sarcoidosis