Impact of COVID Pandemic on Lung Transplantation Program: An Indian Experience

Purpose The emergence of the COVID-19 pandemic is unprecedented and poses a challenge in the history of organ transplantation. 2 main decision making challenges related to Transplantation are : starting immunosuppression which potentially can lead to unfavourable outcomes if recipients develop COVID-19 versus deferring transplantation and accepting associated waitlist mortality. Post COVID fibrotic end stage lung disease phenotype on ECMO support as a bridge to LTx (Lung Transplantation) is an emerging indication worldwide but with challenges. We report an impact of COVID pandemic on Lung Transplantation program ,an Indian experience Methods We did a retrospective study from 1st March 2017 till 15 th October 2020. Demographics, Pre-Existing Lung Diseases, Methods of diagnosing SARS-CoV infection, Transplant status and Treatment for SARS-CoV infection were all taken into consideration Results 140 patients have undergone LTx since the time period mentioned. Out of 140 post LTx patients, 2 recipients ( 1.4%) developed SARS-CoV infection out of which 1 patient expired. Out of 24 patients on waitlist from March 2020 to October 2020, 7 patients (29%) developed SARS-CoV Infection. Out of these 7 patients on waitlist, 3 patients (42%) recovered and underwent BLTx (Bilateral) successfully , 3 patients expired (42%) and 1 patient is awaiting LTx. Among these 7 patients awaiting LTx, pre-operatively, 1 had severe PAH (14%), 1 had End Stage Sarcoidosis (14%), 2 had post COVID fibrotic end stage lung disease on ECMO support (28%) and 3 patients had RA-ILD (42%). Among 3 patients while awaiting LTx who expired, 2 patients had underlying post COVID fibrotic end stage lung disease on ECMO support and 1 patient had RA-ILD (Rheumatoid). Conclusion Post Lung Transplantation , few recipients seems to be developing SARS-CoV infection although we require larger retrospective studies for the same. Post COVID fibrotic end stage lung disease phenotype on ECMO support as a bridge to LTx may have significant waitlist mortality and candidacy for LTx should be judiciously determined.