• Flavio Pola Dos Reis, Lucas Matos Fernandes, Luis Gustavo Abdalla, Silvia Vidal Campos, Priscila Cilene Leon Bueno de Camargo, Samuel Lucas Dos Santos, Ivana Teixeira de Aguiar, Juliana Patricia Pires, Andre Nathan Costa, Rafael Medeiros Carraro, Ricardo Henrique de Oliveira Braga Teixeira, and Paulo Manuel Pêgo-Fernandes.
• MD. Attending Surgeon, Thoracic Surgery Program, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
• Sao Paulo Med J. 2021 Dec 17; 140 (1): 153159153-9.

BackgroundLung transplantation (LTx) has been discussed as an option for treating irreversible lung fibrosis post-coronavirus disease 2019 (COVID-19), in selected cases.ObjectivesTo report on the initial experience and management of end-stage lung disease due to COVID-19 at a national center reference in Brazil.Design And SettingCohort study conducted at a national reference center for lung transplantation.MethodsMedical charts were reviewed regarding patients' demographics and pre-COVID-19 characteristics, post-LTx due to COVID-19.ResultsBetween March 2020 and September 2021, there were 33 cases of LTx. During this period, we evaluated 11 cases of severe COVID-19-related acute respiratory distress syndrome (ARDS) that were potentially candidates for LTx. Among these, LTx was only indicated for three patients (9.1%). All of these patients were on venovenous extracorporeal membrane oxygenation (ECMO), and the procedure that they underwent was central venoarterial ECMO. All three patients were still alive after the first 30 postoperative days. However, patient #1 and patient #2 subsequently died due to fungal sepsis on the 47th and 52nd postoperative days, respectively. Patient #3 was discharged on the 30th postoperative day.ConclusionsLTx is feasible among these complex patients. Survival over the first 30 days was 100%, and this favors surgical feasibility. Nonetheless, these were critically ill patients.

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