A recent study published by researchers at the University of Florida reports that bilateral orthotopic lung transplantation (BOLT) was a life‑saving treatment for patients with end‑stage pulmonary disease caused by COVID‑19, even when those patients required prolonged extracorporeal membrane oxygenation (ECMO) support.
The article, “Clinical Characteristics and Postoperative Outcomes of Bilateral Lung Transplantation for COVID-19–Induced End-Stage Pulmonary Disease: A Single-Center Experience in a High Acuity Patient Population,” was published in the Journal of Cardiothoracic and Vascular Anesthesia. It was coauthored by Department of Anesthesiology faculty T. Everett Jones, M.D., Michael Franklin, D.O., Terrie Vasilopoulos, Ph.D., and Yong G. Peng, M.D., Ph.D., former fellow Muna Oli, M.D., and colleagues from the Departments of Surgery and Medicine as well as the University of Miami and the Sarasota Memorial Healthcare System.
The researchers examined 37 patients treated between 2020 and 2022 who had severe COVID‑19–related lung injuries and ultimately received BOLTs. More than a third of these patients had developed acute respiratory distress syndrome, and some had previously received ECMO. The study found that all recipients survived the immediate postoperative period, and that a multidisciplinary approach allowed for ECMO removal, intensive care unit discharge, and finally hospital discharge.
Key factors that the researchers identified as influencing postoperative outcomes included the duration of ECMO support before transplant, intraoperative blood loss, and the presence of pulmonary hypertension or right‑ventricular dysfunction. The researchers found that patients who had pulmonary hypertension took about two extra days to be removed from ECMO after the transplant.
“BOLT was a lifesaving procedure for all recipients, despite these patients being among the sickest,” the authors concluded. They also noted modifiable factors that may help to reduce the duration of a patient’s hospital stay and improve their overall recovery.
Congratulations to the authors!
Learn about joining our faculty.
KEY POINTS
- Life‑saving treatment: Bilateral orthotopic lung transplantation (BOLT) resulted in survival for all 37 critically ill COVID‑19 patients studied, including those who had endured prolonged extracorporeal membrane oxygenation (ECMO) support.
- Modifiable variables: Factors such as anticoagulation management, intraoperative blood loss, and optimization of pulmonary hypertension or right‑ventricular function influence both short‑term recovery and overall outcomes.
- Clinical implications: The study supports the use of BOLT as an effective therapeutic strategy for end‑stage COVID‑19 lung disease and highlights the importance of individualized perioperative planning to improve the postoperative course.