The impact of the COVID-19 pandemic on lung transplantation

The SARS-CoV-2 (COVID-19) pandemic has significantly impacted lung transplant programs across the United States. At the height of the pandemic, transplant centers adjusted guidelines for donor selection, management of patients with a positive COVID- 19 diagnosis, and prevention of transmission of COVID-19 to transplant recipients and healthcare workers. The COVID-19 pandemic gave rise to a new subset of patients being referred for lung transplantation. For patients who develop Coronavirus-related acute respiratory distress syndrome (CARDS) or post-COVID-19 pulmonary fibrosis (PCPF) without signs of recovery, lung transplantation can be a lifesaving option but requires careful selection to prevent harm. Extracorporeal life support (ECLS) as a "bridge to lung transplant" for COVID-19-relatedated lung disease and ex vivo lung perfusion (EVLP) as a modality to increase the donor pool have also been discussed. This chapter explores the indications and contraindications for lung transplant candidates with COVID-19 related lung disease and COVID-19 related considerations for managing candidates and recipients. Additionally, we have raised questions about ethical considerations when evaluating patients with COVID-19 related lung disease for lung transplantation. Finally, COVID-19 infection post-lung transplant is also discussed, which adds to the challenge of immunosuppression modulation and treatment based on concerns for drug-drug interactions.