Clinical characteristics and outcomes of lung transplantation in patients with severe COVID-19 infection: A systematic review and meta-analysis

•Critically ill COVID-19 patients have severe lung damage and respiratory failure.•The pooled follow-up survival in lung transplantation (LTx) for COVID-19 was 87.40%.•Patients with severe COVID-19 receiving LTx had acceptable short-term outcomes.•LTx is suggested as a viable lifesaving treatment for severe COVID-19.•Follow-up survival was higher in COVID-19 LTx than in non-COVID-19 LTx (P = 0.04). To synthesize the clinical experience of patients with COVID-19-associated acute respiratory distress syndrome (ARDS) or pulmonary fibrosis (PF) receiving lung transplantation (LTx) and compare the characteristics and outcomes of COVID-19 and non-COVID-19 LTx patients. A literature search of online databases (PubMed, Web of Science, Embase, the Cochrane Library, China Science and Technology Journal Database, and Wan Fang databases) was performed regarding LTx for COVID-19–associated ARDS or PF. This study was registered on PROSPERO (CRD2024507647). Eight eligible studies were included with 478 COVID-19 LTx patients and 163 non-COVID-19 LTx patients. In COVID-19 LTx patients, the pooled hospital mortality and follow-up survival rate was 0.00% (95% CI 0.00-0.03) and 87.40% (95% CI 0.76-0.96). Compared to non-COVID-19 LTx patients, COVID-19 LTx patients were associated with significantly higher rate of primary graft dysfunction (odds ratio [OR] 8.72, 95% CI 3.54-21.47, P < 0.001) but significantly higher follow-up survival rate (OR 2.48, 95% CI 1.02-6.01, P = 0.04), within an overall similar follow-up period. For patients with COVID-19–associated ARDS or PF, LTx offers acceptable short-term outcomes and is suggested as a viable lifesaving treatment.