J Thorac Cardiovasc Surg. 2026 Oct 19:S0022-5223(26)01384-X. doi: 10.1016/j.jtcvs.2026.09.031. Online ahead of print.
ABSTRACT
BACKGROUND: Lung transplantation is a feasible therapeutic option for irreversible lung injury caused by COVID-19, but comprehensive mid-term outcome data remain limited. This study evaluated outcomes after lung transplantation for COVID-19 acute respiratory distress syndrome (CARDS) and post-COVID pulmonary fibrosis (CPF) using a national registry.
METHODS: We performed a retrospective analysis of the United Network for Organ Sharing database from 2020 through 2024. Recipient characteristics, perioperative complications, and graft failure-free survival were analyzed in adult lung transplant recipients with a primary diagnosis of CARDS, CPF, or non-COVID restrictive lung disease (NCRLD). Inverse probability of treatment weighting (IPTW) and multivariate logistic regression were performed to adjust for potential confounders.
RESULTS: During the study period, 256 transplants were performed for CARDS, 338 for CPF, and 8071 for NCRLD. Post-COVID-19 recipients were younger (54 vs. 64 years, p<0.001) and required a higher level of care preoperatively than NCRLD recipients. Posttransplant, post-COVID-19 recipients experienced higher rates of posttransplant ECMO (22.6% vs. 10.3%, p<0.001), ventilation >48 hours (67.5% vs. 43.3%, p<0.001), new dialysis (11.0% vs. 7.9%, p=0.012), and acute rejection (7.7% vs. 5.5%, p=0.026). Graft failure-free survival was equivalent throughout the first year posttransplant between the post-COVID-19 and NCRLD recipients and, after IPTW for age and other confounders, was equivalent for up to 3 years (Hochberg-adjusted p=0.118).
CONCLUSIONS: Lung transplantation for post-COVID-19 lung damage yields comparable short-term and mid-term survival outcomes despite higher perioperative morbidity and resource utilization. Long-term studies are needed to assess chronic lung allograft dysfunction in this population.
PMID:42896671 | DOI:10.1016/j.jtcvs.2026.09.031