Lung Transplantation for Severe Post-coronavirus Disease 2019 Respiratory Failure
Lung Transplantation for Severe Post-coronavirus Disease 2019 Respiratory Failure
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DOI：
10.1097/tp.0000000000003706
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发表时间：
2021-06-01
期刊：
影响因子：
6.2
通讯作者：
Roeser, Mark
中科院分区：
文献类型：
--
作者：
Hawkins, Robert B.;Mehaffey, J. Hunter;Roeser, Mark
背景2019冠状病毒病（COVID-19）大流行已导致超过7200万例病例和160万例死亡。COVID-19导致的终末期肺病是一种可能从肺移植中受益的新的和不断增长的实体;然而，关于患者选择，围手术期管理和移植预期结果的数据有限。通过检索MEDLINE和Web of Science数据库以及灰色文献对文献进行系统评价。纳入了肺移植治疗COVID相关呼吸衰竭的所有手稿、社论、评论和灰色文献报告。弗吉尼亚大学的一个案例被描述并包括在综述中。共纳入27项研究：11篇手稿，5篇评论和11篇灰色文献报告。因COVID相关肺病而进行的移植总数为21例。平均年龄为55 +/- 12岁，16例（76%）为男性，视力较高，术前体外膜肺氧合的患者占85%。早期存活率为95%，另有1例晚期死亡。有越来越多的组织病理学证据表明，在移植时没有复制病毒的永久性结构损伤。对于继发于COVID-19的终末期肺衰竭患者，双侧肺移植是一种有效的治疗选择，具有合理的短期结局。然而，对这一新人群的具体考虑需要采取多学科办法。随着我们进入COVID-19全球大流行的第二波，肺移植可能会在这些复杂患者的管理中发挥越来越大的作用。
Background. The coronavirus disease 2019 (COVID-19) pandemic has resulted in >72 million cases and 1.6 million deaths. End-stage lung disease from COVID-19 is a new and growing entity that may benefit from lung transplant; however, there are limited data on the patient selection, perioperative management, and expected outcomes of transplantation for this indication.Methods. A systematic review of the literature was performed with searches of MEDLINE and Web of Science databases as well as the gray literature. All manuscripts, editorials, commentaries, and gray literature reports of lung transplantation for COVID-related respiratory failure were included. A case from the University of Virginia is described and included in the review.Results. A total of 27 studies were included: 11 manuscripts, 5 commentaries, and 11 gray literature reports. The total number of transplantations for COVID-related lung disease was 21. The mean age was 55 +/- 12 years, 16 (76%) were male individuals, and the acuity was high, with 85% on extracorporeal membrane oxygenation preoperatively. There was a 95% early survival rate, with 1 additional late death. There is growing histopathologic evidence for permanent structural damage with no replicating virus at the time of transplantation.Conclusions. Bilateral lung transplantation is an effective treatment option with reasonable short-term outcomes for patients with end-stage lung failure secondary to COVID-19. However, specific considerations in this new population require a multidisciplinary approach. As we move into the second wave of the COVID-19 global pandemic, lung transplantation will likely have a growing role in management of these complex patients.