Outcomes of lung transplantation from COVID-19-positive donors: a systematic review and meta-analysis

Abstract Background Lung transplant is a life-saving therapy for end stage lung disease. However, the shortage of donor organs limits its availability. The safety of utilizing lungs from COVID-19-positive donors remains uncertain due to potential transmission risks and variable practice patterns. This study aimed to compare allografts from COVID-19-positive donors and COVID-19-negative donors during lung transplantation, with a focus on survival, length of hospital stay, dialysis, 30-day graft failure, 30-day mortality and postoperative ECMO support. Methods PubMed, Scopus, and Embase were assessed. Four studies including 5,921 patients were included. Overall survival was estimated by the Kaplan-Meier method and compared with Cox proportional hazards models. Random-effects models were applied for all pooled analyses. Results There was no difference in overall survival (HR 1.35; 95% CI 0.67–2.71; p = 0.40), and dialysis (RR = 1.38; 95% CI 0.52–3.64; p = 0.52) between groups. Recipients of allografts from COVID-19-positive donors had longer hospital stay (MD = 6.43 days; 95% CI 1.53–11.33; p = 0.01). There were no significant differences between groups for 30-day graft failure (RR = 1.08; 95% CI 0.83–1.39; p = 0.58), 30-day mortality (RR = 1.76; 95% CI 0.75–4.13; p = 0.19), or ECMO within 72 h (RR = 0.61; 95% CI 0.14–2.58; p = 0.50). Conclusions Although outcomes of transplantation were comparable, recipients of lungs from COVID-19-negative donors had shorter hospital stay. However, these results should be interpreted with caution due to the limited number of available comparative studies reflecting the current evidence base, and variations in methods of ascertaining COVID-19 positivity across studies.