Abstract
Objectives: To determine whether bilateral orthotopic lung transplantation (BOLT) in patients on prolonged extracorporeal membrane oxygenation (ECMO) support for COVID-19-related end-stage lung disease is safe and effective and whether any perioperative factors affect outcomes. Design: A retrospective analysis. Setting: A single university hospital. Participants: Data were collected from 37 patients with COVID-19-related end-stage lung disease with a median United Network for Organ Sharing lung allocation score of 85.83 who underwent BOLT between May 2020 and April 2022. Interventions: None. Measurements and Main Results: Patients' perioperative data were collected from Epic electronic medical records (Epic Systems). Thirty-seven patients were included in the analyses, with 49% exhibiting right ventricular dysfunction and 41% having pulmonary hypertension. Primary outcomes were duration from surgery to ECMO decannulation, duration from BOLT surgery to hospital discharge, and intensive care unit duration. Patients with pulmonary hypertension, compared to those without, had longer median days to ECMO decannulation (4 days v 2 days, p = 0.014). Longer overall hospital stays were associated with greater intraoperative administration of cell saver (p = 0.043), 5% albumin (p = 0.031), 25% albumin (p = 0.027), and packed red blood cells (p = 0.015). Greater intraoperative packed red blood cells were also associated with a longer intensive care unit duration. Conclusions: The current study on BOLT for critically ill patients with end-stage lung disease secondary to COVID-19 infection provides additional information regarding the perioperative management of these patients and factors that may influence recovery trajectories in this high-risk population. (c) 2026 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.