Lung transplantation as therapeutic option in acute respiratory distress syndrome for coronavirus disease 2019-related pulmonary fibrosis
Lung transplantation as therapeutic option in acute respiratory distress syndrome for coronavirus disease 2019-related pulmonary fibrosis
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DOI：
10.1097/cm9.0000000000000839
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发表时间：
2020-06-20
影响因子：
6.1
通讯作者：
He, Jian-Xing
中科院分区：
文献类型：
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作者：
Chen, Jing-Yu;Qiao, Kun;He, Jian-Xing
背景
2019冠状病毒病（COVID - 19）重症患者，即使核酸检测结果已转为阴性以及接受了最大限度的医疗支持，也已被注意到会进展为不可逆的致命性呼吸衰竭。肺移植（LT）作为与急性呼吸窘迫综合征相关的终末期肺纤维化的唯一治疗方法，被认为是这些患者的最终挽救性治疗手段。
方法
2020年2月10日至3月10日，对3名男性患者进行了紧急评估并列入移植名单。在进行了全面的伦理审查并获得患者家属同意后，我们对病程超过1个月且序贯器官衰竭评估评分极高的COVID - 19患者实施了3例肺移植手术。
结果
3名受者中有2名在肺移植术后存活，并开始参与康复计划。总结并不断完善了肺移植团队协作和围手术期后勤保障的要点。切除肺的病理结果与严重的临床表现相符，为更好地理解该疾病提供了见解。政府卫生事务系统、病毒学检测工具和现代通信技术都对患者的生存及其康复起着关键作用。
结论
对于因COVID - 19相关肺纤维化导致呼吸衰竭的终末期患者可以进行肺移植。如果病毒学状态确认为阳性转阴性且无可能禁忌肺移植的器官功能障碍，肺移植为这些患者避免必死提供了最终选择，同时要对移植外科医生和医务人员进行适当保护。通过确保对患者和医疗团队提供即时无缝的护理，可以实现降低COVID - 19患者死亡率和挽救患者生命的目标。
Background Critical patients with the coronavirus disease 2019 (COVID-19), even those whose nucleic acid test results had turned negative and those receiving maximal medical support, have been noted to progress to irreversible fatal respiratory failure. Lung transplantation (LT) as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients. Methods From February 10 to March 10, 2020, three male patients were urgently assessed and listed for transplantation. After conducting a full ethical review and after obtaining assent from the family of the patients, we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores. Results Two of the three recipients survived post-LT and started participating in a rehabilitation program. Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved. The pathological results of the explanted lungs were concordant with the critical clinical manifestation, and provided insight towards better understanding of the disease. Government health affair systems, virology detection tools, and modern communication technology all play key roles towards the survival of the patients and their rehabilitation. Conclusions LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis. If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT, LT provided the final option for these patients to avoid certain death, with proper protection of transplant surgeons and medical staffs. By ensuring instant seamless care for both patients and medical teams, the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.