Early outcomes after lung transplantation for severe COVID-19: a series of the first consecutive cases from four countries.
Early outcomes after lung transplantation for severe COVID-19: a series of the first consecutive cases from four countries.
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DOI：
10.1016/s2213-2600(21)00077-1
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发表时间：
2021-05
期刊：
影响因子：
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通讯作者：
Hoetzenecker K
中科院分区：
文献类型：
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作者：
Bharat A;Machuca TN;Querrey M;Kurihara C;Garza-Castillon R Jr;Kim S;Manerikar A;Pelaez A;Pipkin M;Shahmohammadi A;Rackauskas M;Kg SR;Balakrishnan KR;Jindal A;Schaheen L;Hashimi S;Buddhdev B;Arjuna A;Rosso L;Palleschi A;Lang C;Jaksch P;Budinger GRS;Nosotti M;Hoetzenecker K
肺移植是终末期肺病患者的一种挽救生命的治疗方法;然而，对于感染性原因引起的急性呼吸窘迫综合征（ARDS）患者，很少考虑肺移植。我们的目的是描述尽管进行了最佳医疗管理但仍未能显示肺恢复的COVID-19重症患者的病程和早期移植后结局，这些患者被认为因肺部并发症而面临死亡的紧迫风险。我们建立了一个多机构病例系列，其中包括我们在美国、意大利、奥地利和印度已知的严重COVID-19相关ARDS的首次连续移植。西北大学（芝加哥，IL，USA）收集并分析了来自参与中心的去识别数据，包括与患者人口统计学和COVID-19前特征、移植前病程、围手术期挑战、移植肺病理学和移植后结局相关的信息。2020年5月1日至9月30日期间，12名COVID-19相关ARDS患者在美国（3个中心8名受者）、意大利（1个中心2名受者）、奥地利（1名受者）和印度（1名受者）的6个大容量移植中心接受了双侧肺移植。接受者的中位年龄为48岁（IQR 41-51）; 12例患者中有3例为女性。移植前的胸部影像学显示严重的肺损伤，尽管延长了机械通气和体外膜肺氧合，但没有改善。肺移植手术在技术上具有挑战性，伴有严重的胸膜粘连、肺门淋巴结病和术中输血需求增加。受损肺的病理学显示广泛的、持续的急性肺损伤，具有肺纤维化的特征。移植物中无SARS-CoV-2复发。所有感染COVID-19的患者都可以脱离体外支持，并显示出与未感染COVID-19的移植受者相似的短期生存率。我们报告的结果表明，肺移植是一些患有严重的、未消退的COVID-19相关ARDS患者生存的唯一选择，并且在精心挑选的患者中，该手术可以成功完成，移植后早期结局良好。国立卫生研究院。严重COVID-19肺移植后的早期结局
Lung transplantation is a life-saving treatment for patients with end-stage lung disease; however, it is infrequently considered for patients with acute respiratory distress syndrome (ARDS) attributable to infectious causes. We aimed to describe the course of disease and early post-transplantation outcomes in critically ill patients with COVID-19 who failed to show lung recovery despite optimal medical management and were deemed to be at imminent risk of dying due to pulmonary complications. We established a multi-institutional case series that included the first consecutive transplants for severe COVID-19-associated ARDS known to us in the USA, Italy, Austria, and India. De-identified data from participating centres—including information relating to patient demographics and pre-COVID-19 characteristics, pretransplantation disease course, perioperative challenges, pathology of explanted lungs, and post-transplantation outcomes—were collected by Northwestern University (Chicago, IL, USA) and analysed. Between May 1 and Sept 30, 2020, 12 patients with COVID-19-associated ARDS underwent bilateral lung transplantation at six high-volume transplant centres in the USA (eight recipients at three centres), Italy (two recipients at one centre), Austria (one recipient), and India (one recipient). The median age of recipients was 48 years (IQR 41–51); three of the 12 patients were female. Chest imaging before transplantation showed severe lung damage that did not improve despite prolonged mechanical ventilation and extracorporeal membrane oxygenation. The lung transplant procedure was technically challenging, with severe pleural adhesions, hilar lymphadenopathy, and increased intraoperative transfusion requirements. Pathology of the explanted lungs showed extensive, ongoing acute lung injury with features of lung fibrosis. There was no recurrence of SARS-CoV-2 in the allografts. All patients with COVID-19 could be weaned off extracorporeal support and showed short-term survival similar to that of transplant recipients without COVID-19. The findings from our report show that lung transplantation is the only option for survival in some patients with severe, unresolving COVID-19-associated ARDS, and that the procedure can be done successfully, with good early post-transplantation outcomes, in carefully selected patients. National Institutes of Health. Early outcomes after lung transplantation for severe COVID-19