Lung transplants encouraging treatment for COVID-19 patients, but long-term outcomes still uncertain

Recent data bolster the value of lung transplants for some COVID-19 patients, indicating they do as well after surgery as those who needed new lungs for other reasons.

The complicated, risky procedure remains rare, though, doctors said, and there is still much they’re learning about how well transplants work for COVID-19 patients.

“No institution has that long-time survival data because it started earliest 2020 March or April,” said Norihisa Shigemura, a Temple University Hospital physician who performs lung transplants. “It’s still too early to say whether this will bring a long-term benefit or not.”

Just over 95% of COVID-19 patients who received lung transplants from August 2020 through September 2021 were still alive after three months, according to a Jan. 26 study from the New England Journal of Medicine, about the same survival rate as is seen in lung-transplant patients overall. Causes of death for those who didn’t survive included stroke, transplant rejection, and being put back on an extracorporeal membrane oxygenation (ECMO) machine, which does the work of lungs by adding oxygen to blood. Among those patients who needed lung transplants due to COVID-19 infections, just over 2% died in the first 30 days after the surgery, the study found.

» READ MORE: Rare, risky, and complex, lung transplants for COVID-19 survivors save, but change, lives

Of the more than 3,000 lung transplants performed in the study period, just 7% were needed because of lung damage caused by COVID-19, the study stated. Temple Hospital has performed 19 lung transplants on COVID-19 patients, and all lived beyond three months, Shigemura said. One man died six months after transplant surgery from a heart issue possibly related to his COVID-19 infection, he said.

Severe COVID-19 infections can do grievous harm to lungs, scarring them so badly the person needs to be put on a ventilator or ECMO machine. Not all patients whose lungs are badly damaged are eligible for transplants, though. Physicians reserve it for people who are most likely to survive.

Transplanted lungs are inherently vulnerable, doctors said, because they are constantly exposed to the outside environment, including the bacteria and fungi that could be present with every breath. Long-term survival rates for lung-transplant patients tend to be lower than those with other transplanted organs, and people with transplanted lungs are at high risk if they catch COVID-19 again, Shigemura said. Mortality rates among transplant patients who contract COVID-19 are around 30%, he said. People with transplanted lungs also have to restrict their diet and live with a regimen of immunosuppressant drugs to prevent rejection, and a schedule of frequent doctors visits and tests.

For patients who would die without a transplant though, the surgery can offer a last chance at survival.

“I’m able to go hunting, able to do everything I was doing before,” said John Silknitter, 68, of Spring City, who received a single lung in April 2021 at Temple.

He was one of the patients whose lungs suffered extensive scarring during his COVID-19 infection. He was likely weeks from death, he said, barely able to walk across the room without running out of breath, when a new lung became available.

“I can run up the stairs now,” he said.

His recovery hasn’t been without complications, though, he said. He experiences an irregular heartbeat occasionally, and it isn’t clear why. He expects a three-day hospital stay soon to determine the cause.

Patients who need lung transplants because of COVID-19 skew younger and healthier than the typical prepandemic patients, and doctors are hopeful they could look forward to improved survival rates as years pass.

Because lung transplants are so complicated, though, they remain a remedy of last resort, and Shigemura said doctors are getting better at helping COVID-19 patients recover without the procedure. Experimental medications and a better understanding of the virus has led to patients recovering lung function even after experiencing damage that a few years ago would have been considered irreversible. Shigemura described such recoveries as “like miracles.”

“We learned from these lessons that the question still remains, where is the irreversible point that each patient needs lung transplantation or still may be able to recover?” he said.

Silknitter continues to marvel at his health after his own surgery. He feels better now than he did before he caught COVID-19. Last year, shortly after he left the hospital following his surgery, he attended an annual golf tournament held to memorialize his late brother, but he could only watch. This year, he said, he plans on playing in it.

“I think about when I do things, I think the other day I couldn’t walk across the room,” he said. “It’s like night and day.”