Background: Transplantation can offer to selected COVID-19-ARDS patients with irreversible lung disease an excellent short-term outcome. However, the long-term outcome after lung transplant for COVID-19 associated ARDS is not known.

Methods: we analyzed lung transplantations performed between 05/2020-04/2022 due to COVID-19 ARDS. All consecutive patients receiving a primary lung transplantation were included in this retrospective analysis.

Results: Twenty-nine COVID-19 associated ARDS patients were transplanted at the medical university of Vienna. 25 (86%) males and 4 (14%) females, with a median age of 54 years, and median lung allocation score of 89.6. No induction therapy was used, except for one highly presensitized recipient. The median duration of intensive care unit stay was 48. 9 days. We used Torque-Teno-Virus for tailoring the immunosuppressive therapy. Eleven patients (37.9%) died in the first postoperative year, 9 from secondary sclerosing cholangitis. Two patients received liver transplantation. We identified 2 patients with acute humoral, and five with acute cellular rejection, 7 patients have persistent donor specific antibodies. None of the patients developed an early CLAD. Eight patients were treated with multiresistent bacteria, thirteen for fungal infections, and one for CMV viremia. The health-related quality of life was measured with SF-36 questionnaire.

Conclusion: Despite a prolonged postoperative stay and often-complicated postoperative course lung transplantation was an effective and life-saving treatment for patients suffered from COVID-19 associated ARDS. The health-related quality of life benefit was after a year similar to those with other organ tranplantation.