LAUSR

INTRODUCTION: In the current COVID-19 pandemic, no proven effective treatment is available Critical patients with COVID-19, have been noted to progress to irreversible fatal respiratory failure Lung transplantation could be a life-saving procedure for COVID-19 patients with extensive pulmonary fibrosis We aim to highlight this therapeutic surgical management in terms of its indications, efficacy and safety METHODS: A systematic search was conducted for articles published between inception and July 18th, 2020 focusing on lung transplant as a therapeutic approach for severe lung damage in patients with COVID-19 The primary outcomes defined were efficacy and safety of lung transplant based on the pooled available data along with the peri-operative management RESULTS: Four studies (two case reports and two case series) were included in systematic review A total of seven patients were included, with a female: male ratio of 0 75: 1 The mean age of the patients was 56 8 years All of these patients suffered from end stage respiratory failure due to irreversible lung damage even after sero-conversion Six patients underwent bilateral lung transplant and one patient underwent only right lung transplant The median (IQR) interval between the diagnosis of COVID-19 and lung transplant surgery was 39 2 (28-56) days Post-operatively, five patients had no complications and recovered well One patient had acute rejection of the graft which was managed by steroid pulse therapy while one patient succumbed to death on post-operative day-one CONCLUSIONS: Lung transplantation could be considered as a treatment option for end-stage COVID-19 patients with extensive pulmonary fibrosis leading to respiratory failure It could be the potential last resort in sero-converted patients without multiple organ dysfunction