Early outcomes of lung transplantation with lung allografts from COVID-19-positive donors

Objective Coronavirus disease 2019 (COVID-19) can be detected for extended periods of time with nucleic acid amplification test (NAAT) even after transmissibility becomes negligible. Lung allografts from COVID-19-positive donors have been used for transplantation in highly selected cases. This study aimed to clarify the early outcomes of lung transplantation with COVID-19-positive donors. Methods The Organ Procurement and Transplantation Network/United Network for Organ Sharing database between April 2020 and June 2022 was retrospectively analyzed using univariate tests. Results In the study period, 1,297 COVID-19-positive donors were identified and the lungs were transplanted from 47 donors (3.6%). Of 47 donors, 44 donors were positive for COVID-19 NAT with nasopharyngeal swabs and the other three were positive with bronchoalveolar lavage. The COVID-19-positive lung donors were younger than the COVID-19-negative donors (28.4 ± 11.6 years vs. 35.4 ± 13.6 years, P < .001). Recipients of the COVID-19-positive lungs (n = 47) were more likely have a higher lung allocation score (LAS) (57.1 ± 22.9 vs. 50.5 ± 19.7, P = .057) than recipients of COVID-19-negative lungs (n = 5,501). The post-transplant length of hospital stay (39.8 ± 43.6 days vs 30.6 ± 34.5 days, P = .181), need for extracorporeal membrane oxygenation (ECMO) support at 72 hours after transplantation (2.6% [1/38] vs 10.4% [541/5,184], P = 0.18), and 1-year overall survival rate (85.6% vs 87.1%, P = .63) were comparable between the two groups. Conclusions Carefully selected lung allografts from COVID-19-positive donors had comparable early post-transplant outcomes to lung allografts from COVID-19-negative donors. Coronavirus disease 2019 (COVID-19) can be detected for extended periods of time with nucleic acid amplification test (NAAT) even after transmissibility becomes negligible. Lung allografts from COVID-19-positive donors have been used for transplantation in highly selected cases. This study aimed to clarify the early outcomes of lung transplantation with COVID-19-positive donors. The Organ Procurement and Transplantation Network/United Network for Organ Sharing database between April 2020 and June 2022 was retrospectively analyzed using univariate tests. In the study period, 1,297 COVID-19-positive donors were identified and the lungs were transplanted from 47 donors (3.6%). Of 47 donors, 44 donors were positive for COVID-19 NAT with nasopharyngeal swabs and the other three were positive with bronchoalveolar lavage. The COVID-19-positive lung donors were younger than the COVID-19-negative donors (28.4 ± 11.6 years vs. 35.4 ± 13.6 years, P < .001). Recipients of the COVID-19-positive lungs (n = 47) were more likely have a higher lung allocation score (LAS) (57.1 ± 22.9 vs. 50.5 ± 19.7, P = .057) than recipients of COVID-19-negative lungs (n = 5,501). The post-transplant length of hospital stay (39.8 ± 43.6 days vs 30.6 ± 34.5 days, P = .181), need for extracorporeal membrane oxygenation (ECMO) support at 72 hours after transplantation (2.6% [1/38] vs 10.4% [541/5,184], P = 0.18), and 1-year overall survival rate (85.6% vs 87.1%, P = .63) were comparable between the two groups. Carefully selected lung allografts from COVID-19-positive donors had comparable early post-transplant outcomes to lung allografts from COVID-19-negative donors.