Timing of Lung Transplant Referral in Patients with Severe COVID-19 Lung Injury Supported by ECMO

Liran Levy*, Ofir Deri, Ella Huszti, Eyal Nachum, Stephane Ledot, Nir Shimoni, Milton Saute, Leonid Sternik, Ran Kremer, Yigal Kassif, Nona Zeitlin, Jonathan Frogel, Ilya Lambrikov, Ilia Matskovski, Sumit Chatterji, Lior Seluk, Nadav Furie, Inbal Shafran, Ronen Mass, Amir OnnEhud Raanani, Amir Grinberg, Yuval Levy, Arnon Afek, Yitshak Kreiss, Alexander Kogan

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Severe respiratory failure caused by COVID-19 often requires mechanical ventilation, including extracorporeal membrane oxygenation (ECMO). In rare cases, lung transplantation (LTx) may be considered as a last resort. However, uncertainties remain about patient selection and optimal timing for referral and listing. This retrospective study analyzed patients with severe COVID-19 who were supported by veno-venous ECMO and listed for LTx between July 2020 and June 2022. Out of the 20 patients in the study population, four who underwent LTx were excluded. The clinical characteristics of the remaining 16 patients were compared, including nine who recovered and seven who died while awaiting LTx. The median duration from hospitalization to listing was 85.5 days, and the median duration on the waitlist was 25.5 days. Younger age was significantly associated with a higher likelihood of recovery without LTx after a median of 59 days on ECMO, compared to those who died at a median of 99 days. In patients with severe COVID-19-induced lung damage supported by ECMO, referral to LTx should be delayed for 8–10 weeks after ECMO initiation, particularly for younger patients who have a higher probability of spontaneous recovery and may not require LTx.

Original languageEnglish
Article number4041
JournalJournal of Clinical Medicine
Issue number12
StatePublished - Jun 2023


  • acute respiratory distress syndrome (ARDS)
  • coronavirus disease 2019 (COVID-19)
  • extracorporeal membrane oxygenation (ECMO)
  • lung transplant


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