Table 1.

Considerations Prior to Transplant in Outpatients With Post-COVID Fibrosis

Assess for evidence of preexisting ILD
•History: Symptoms before COVID-19 infection, family history of ILD, connective tissue disease history or signs/symptoms, occupational or other exposures associated with chronic hypersensitivity pneumonitis
•Review available chest imaging from before COVID-19 infection
•Consider connective tissue disease testing
Obtain baseline PFTs, 6MWT, and imaging, and monitor serially
Consider a trial of corticosteroids
Consider anti-fibrotic (pirfenidone or nintedanib) if evidence of progression
Refer for pulmonary rehabilitation
Transplantation is reserved for severe debility failing to improve with time, medical therapy, and rehabilitation or progressive disease

6MWT = 6-min walk test; ILD = interstitial lung disease; PFT = pulmonary function testing