The COVID-19 pandemic has caused acute lung injury in millions of individuals worldwide. Some patients develop COVID-related acute respiratory distress syndrome (CARDS) and cannot be liberated from mechanical ventilation. Others may develop post-COVID fibrosis resulting in substantial disability and need for long-term supplemental oxygen. In both of these situations, treatment teams often inquire about the possibility of lung transplantation. In fact, lung transplantation has been successfully employed for both CARDS and post-COVID fibrosis in a limited number of patients worldwide. Lung transplantation following COVID infection presents a number of unique challenges that transplant programs must consider. In those with severe CARDS, the inability to conduct proper psychosocial evaluation and pre-transplant education, marked deconditioning from critical illness, and infectious concerns regarding viral re-activation are major hurdles. In those with post-COVID fibrosis, our limited knowledge about the natural history of recovery following COVID-19 infection is problematic. Increased knowledge of the likelihood and degree of recovery following COVID-19 acute lung injury is essential for appropriate decision making with regard to transplant. Transplant physicians must weigh the risks and benefits of lung transplant differently in a post-COVID fibrosis patient who is likely to remain stable or gradually improve in comparison to a patient with a known progressive fibrosing interstitial lung disease (fILD). It is clear that lung transplantation can be a life-saving therapeutic option for some patients with severe lung injury from COVID-19 infection. In this review, we discuss how lung transplant providers from a number of experienced centers approach lung transplantation for CARDS or post-COVID fibrosis.
Copyright © 2021 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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