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Gill G, O'Connor M, Nunnally ME, Combes A, Harper M, Baran D, Avila M, Pisani B, Copeland H, Nurok M. Lessons Learned From Extracorporeal Life Support Practice and Outcomes During the COVID-19 Pandemic. Clin Transplant 2024; 38:e15482. [PMID: 39469754 DOI: 10.1111/ctr.15482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Accepted: 09/27/2024] [Indexed: 10/30/2024]
Abstract
Extracorporeal membrane oxygenation is increasingly being used to support patients with hypoxemic respiratory failure and cardiogenic shock. During the COVID-19 pandemic, consensus guidance recommended extracorporeal life support for patients with COVID-19-related cardiopulmonary disease refractory to optimal conventional therapy, prompting a substantial expansion in the use of this support modality. Extracorporeal membrane oxygenation was particularly integral to the bridging of COVID-19 patients to heart or lung transplantation. Limited human and physical resources precluded widespread utilization of mechanical support during the COVID-19 pandemic, necessitating careful patient selection and optimal management by expert healthcare teams for judicious extracorporeal membrane oxygenation use. This review outlines the evidence supporting the use of extracorporeal life support in COVID-19, describes the practice and outcomes of extracorporeal membrane oxygenation for COVID-19-related respiratory failure and cardiogenic shock, and proposes lessons learned for the implementation of extracorporeal membrane oxygenation as a bridge to transplantation in future public health emergencies.
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Affiliation(s)
- George Gill
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Michael O'Connor
- Department of Anesthesia and Critical Care, University of Chicago Medicine, Chicago, Illinois, USA
| | - Mark E Nunnally
- Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University Langone Health, New York, New York, USA
| | - Alain Combes
- Service de Médecine Intensive-Réanimation, Sorbornne Université, Paris, France
| | - Michael Harper
- Department of Surgical Critical Care, Medstar Washington Hospital Center, Washington, District of Columbia, USA
| | - David Baran
- Department of Cardiology, Advanced Heart Failure, Transplant and Mechanical Circulatory Support, Cleveland Clinic Heart, Vascular and Thoracic Institute, Weston, Florida, USA
| | - Mary Avila
- Department of Cardiology, Northwell Health, New York, New York, USA
| | - Barbara Pisani
- Department of Internal Medicine, Section of Cardiovascular Medicine, Atrium Wake Forest Baptist, Winston-Salem, North Carolina, USA
| | - Hannah Copeland
- Department of Cardiovascular and Thoracic Surgery, Lutheran Health Physicians, Fort Wayne, Indiana, USA
| | - Michael Nurok
- Department of Anesthesiology, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Lombardi A, Colaneri M, Azzarà C, Saltini P, Viero G, Palomba E, Biscarini S, Gori A, Bandera A. Solid organ transplant in recipients with ongoing SARS-CoV-2 infection: A systematic review of case reports and series. Int J Infect Dis 2024; 147:107214. [PMID: 39179150 DOI: 10.1016/j.ijid.2024.107214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Revised: 08/07/2024] [Accepted: 08/13/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Whether solid organ transplant (SOT) can be safely performed in recipients with ongoing SARS-CoV-2 infection is still a debated question. METHODS A systematic review of the literature on recipients with ongoing SARS-CoV-2 infection at the time of surgery and the associated outcomes. RESULTS From 29 studies, we identified 54 recipients; their median age was 47.5 years, and over half (23/54, 54.85%) were affected by fewer than two comorbidities. Kidney was the most common transplanted organ (24/54, 44.4%). SOT was performed without knowing the ongoing infection in 11.1% (6/54) of patients. On average, 16.1 (SD 23.2) days elapsed between SARS-CoV-2 infection and SOT, with a mean Ct value at diagnosis and transplantation of 29 and 31.9, respectively. Most patients (25/39,64.1%) had received previous COVID-19 vaccinations. Twenty-four patients (45.3%) received an anti-SARS-CoV-2 therapy. Ten patients (18.5%) required oxygen support, while seven (13.7%) were admitted to the intensive care unit. There were two reported cases (3.7%) of all-cause death, while there were no cases of COVID-19-related death. CONCLUSIONS Deliberate SOT of recipients with ongoing SARS-CoV-2 is performed worldwide in candidates of nonlung transplant who are fit, immunized against the virus, and displaying a nonsevere disease course. No COVID-19-related deaths were recorded.
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Affiliation(s)
- Andrea Lombardi
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy.
| | - Marta Colaneri
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy; Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Cecilia Azzarà
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Milan, Italy
| | - Paola Saltini
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Milan, Italy
| | - Giulia Viero
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Milan, Italy
| | - Emanuele Palomba
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Simona Biscarini
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Milan, Italy
| | - Andrea Gori
- Department of Infectious Diseases, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, Milan, Italy; Department of Biomedical and Clinical Sciences "L. Sacco", University of Milan, Milan, Italy
| | - Alessandra Bandera
- Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Infectious Diseases Unit, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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Shah P, Miller C, Parilla G, Daneshmand M, Creel-Bulos C. Outcomes associated with prolonged ECMO in COVID-19 associated ARDS: A single center experience. Perfusion 2024; 39:1213-1221. [PMID: 37970730 DOI: 10.1177/02676591231184710] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Abstract
PURPOSE OF STUDY The COVID-19 pandemic has led to a significant increase in the use of veno-venous extracorporeal membrane oxygenation (V-V ECMO) as a bridge to transplantation versus recovery. Unlike other etiologies of acute respiratory distress syndrome (ARDS), utilization of V-V ECMO in COVID-19 has been associated with longer duration of ECMO support requirements. Our team sought to evaluate outcomes associated with prolonged duration of ECMO support in this patient population. METHODS Single-center retrospective review of patients who were placed on ECMO due to COVID-19 associated ARDS. Specifically examining outcomes-transplant free survival, mortality and discharge rates-of patients requiring V-V ECMO support for greater than 50 days. RESULTS The median age of the cohort was 48 years and 13 patients (72%) were males. The median duration of ECMO support was 84 days (IQR 55-106). 11 patients (61%) had right ventricular dysfunction and 13 patients (72%) had pneumothoraces. There was a 33% percent (n = 6) mortality rate within cohort. One patient continues to require ECMO support at time of abstract submission. 11 patients (61%) patients were discharged, of which 3 patients required a lung transplant. SUMMARY Prolonged V-V ECMO can be associated with comparable outcomes to conventional V-V ECMO runs that are relatively shorter in duration. With availability of device and staffing, prolonged ECMO runs can potentially be justified in a highly selected patient population.
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Affiliation(s)
- Purav Shah
- Department of Pulmonary, Allergy, Critical Care and Sleep Medicine, McKelvey Lung Transplant Center, Emory University School of Medicine, Atlanta, USA
| | - Casey Miller
- Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, USA
| | - Gustavo Parilla
- Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, USA
| | - Mani Daneshmand
- Department of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, USA
| | - Christina Creel-Bulos
- Department of Anesthesiology, Emory University School of Medicine, Atlanta, USA
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, USA
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Kurihara C, Kaiho T, Thomae B, Cerier E, Lung K, Avella Patino D, Toyoda T, Yan Y, Budinger GRS, Bharat A. Contrasting predictors of severe primary graft dysfunction following transplant for chronic and acute respiratory failure. J Thorac Dis 2024; 16:5050-5062. [PMID: 39268121 PMCID: PMC11388248 DOI: 10.21037/jtd-24-100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 06/19/2024] [Indexed: 09/15/2024]
Abstract
Background Lung transplantation represents a pivotal intervention for individuals grappling with end-stage lung diseases, and the role of lung transplantation in acute respiratory distress syndrome (ARDS) patients has garnered increased attention especially after the coronavirus disease 2019 (COVID-19) pandemic. Multiple studies have demonstrated a high incidence of primary graft dysfunction (PGD) in patients with ARDS compared to contemporaneous controls undergoing transplantation for chronic end-stage lung diseases although underlying mechanisms or risk factors remain unknown. This retrospective study investigates the contrasting risk factors for PGD grade 3 in patients with ARDS and chronic respiratory failure undergoing lung transplantation. Methods The study included 293 patients who underwent lung transplantation from January 2018 through June 2023. We performed a multivariate logistic regression analysis using variables from the univariate logistic regression analyses to predict PGD grade 3. Results Our findings reveal distinct predictors for PGD grade 3 in the two cohorts. ARDS patients had higher incidence of PGD grade 3 than non-ARDS patients (30.2% vs. 9.6%, P<0.001). Multivariate logistic regression analysis showed ischemic time [odds ratio (OR) =0.60; 95% confidence interval (CI): 0.40-0.90; P=0.01] as predictor of PGD grade 3 for non-ARDS patients, and age (OR =0.72; 95% CI: 0.52-0.99; P=0.048), pre-operative albumin (OR <0.01; 95% CI: <0.01-0.74; P=0.042) for ARDS patients. Interestingly, there was no notable difference in post-transplant survival between the two groups. Conclusions This study highlights differing risk profiles for severe PGD in ARDS and non-ARDS lung transplant recipients, underscoring the need for tailored approaches in managing these patients. It paves the way for further research to refine strategies aimed at reducing PGD incidence and enhancing transplant outcomes in these distinct populations.
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Affiliation(s)
- Chitaru Kurihara
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Taisuke Kaiho
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Benjamin Thomae
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily Cerier
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kalvin Lung
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Diego Avella Patino
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Takahide Toyoda
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Yuanqing Yan
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - G. R. Scott Budinger
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ankit Bharat
- Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Tasoudis P, Lobo LJ, Coakley RD, Agala CB, Egan TM, Haithcock BE, Mody GN, Long JM. Outcomes Following Lung Transplant for COVID-19-Related Complications in the US. JAMA Surg 2023; 158:1159-1166. [PMID: 37585215 PMCID: PMC10433141 DOI: 10.1001/jamasurg.2023.3489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 05/25/2023] [Indexed: 08/17/2023]
Abstract
Importance The COVID-19 pandemic led to the use of lung transplant as a lifesaving therapy for patients with irreversible lung injury. Limited information is currently available regarding the outcomes associated with this treatment modality. Objective To describe the outcomes following lung transplant for COVID-19-related acute respiratory distress syndrome or pulmonary fibrosis. Design, Setting, and Participants In this cohort study, lung transplant recipient and donor characteristics and outcomes following lung transplant for COVID-19-related acute respiratory distress syndrome or pulmonary fibrosis were extracted from the US United Network for Organ Sharing database from March 2020 to August 2022 with a median (IQR) follow-up period of 186 (64-359) days in the acute respiratory distress syndrome group and 181 (40-350) days in the pulmonary fibrosis group. Overall survival was calculated using the Kaplan-Meier method. Cox proportional regression models were used to examine the association of certain variables with overall survival. Exposures Lung transplant following COVID-19-related acute respiratory distress syndrome or pulmonary fibrosis. Main Outcomes and Measures Overall survival and graft failure rates. Results Among 385 included patients undergoing lung transplant, 195 had COVID-19-related acute respiratory distress syndrome (142 male [72.8%]; median [IQR] age, 46 [38-54] years; median [IQR] allocation score, 88.3 [80.5-91.1]) and 190 had COVID-19-related pulmonary fibrosis (150 male [78.9%]; median [IQR] age, 54 [45-62]; median [IQR] allocation score, 78.5 [47.7-88.3]). There were 16 instances of acute rejection (8.7%) in the acute respiratory distress syndrome group and 15 (8.6%) in the pulmonary fibrosis group. The 1-, 6-, and 12- month overall survival rates were 0.99 (95% CI, 0.96-0.99), 0.95 (95% CI, 0.91-0.98), and 0.88 (95% CI, 0.80-0.94) for the acute respiratory distress syndrome cohort and 0.96 (95% CI, 0.92-0.98), 0.92 (95% CI, 0.86-0.96), and 0.84 (95% CI, 0.74-0.90) for the pulmonary fibrosis cohort. Freedom from graft failure rates were 0.98 (95% CI, 0.96-0.99), 0.95 (95% CI, 0.90-0.97), and 0.88 (95% CI, 0.79-0.93) in the 1-, 6-, and 12-month follow-up periods in the acute respiratory distress cohort and 0.96 (95% CI, 0.92-0.98), 0.93 (95% CI, 0.87-0.96), and 0.85 (95% CI, 0.74-0.91) in the pulmonary fibrosis cohort, respectively. Receiving a graft from a donor with a heavy and prolonged history of smoking was associated with worse overall survival in the acute respiratory distress syndrome cohort, whereas the characteristics associated with worse overall survival in the pulmonary fibrosis cohort included female recipient, male donor, and high recipient body mass index. Conclusions and Relevance In this study, outcomes following lung transplant were similar in patients with irreversible respiratory failure due to COVID-19 and those with other pretransplant etiologies.
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Affiliation(s)
- Panagiotis Tasoudis
- Department of Surgery, Division of Cardiothoracic Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Leonard J. Lobo
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Raymond D. Coakley
- Division of Pulmonary Diseases and Critical Care Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Chris B. Agala
- Department of Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Thomas M. Egan
- Department of Surgery, Division of Cardiothoracic Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Benjamin E. Haithcock
- Department of Surgery, Division of Cardiothoracic Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Gita N. Mody
- Department of Surgery, Division of Cardiothoracic Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Jason M. Long
- Department of Surgery, Division of Cardiothoracic Surgery, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
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Li XC, Sun L, Li T. Neonatal methicillin-resistant Staphylococcus aureus pneumonia-related recurrent fatal pyopneumothorax: A case report and review of literature. World J Clin Cases 2023; 11:7475-7484. [PMID: 37969452 PMCID: PMC10643081 DOI: 10.12998/wjcc.v11.i30.7475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/25/2023] [Accepted: 10/08/2023] [Indexed: 10/25/2023] Open
Abstract
BACKGROUND Although neonatal Staphylococcus aureus pneumonia is common and usually curable, it can also be refractory and life-threatening. Herein, we report a case of severe neonatal community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) necrotizing pneumonia with bilateral recurrent pyopneumothorax, respiratory failure, heart failure, and cardiac arrest. We hope our report will add to the understanding of this disease. CASE SUMMARY An 18-d-old boy presented with cough for five days, fever for three days, and dyspnea for two days. Preadmission chest radiograph revealed high-density shadows in both lungs. On admission, his oxygen saturation fluctuated around 90% under synchronized intermittent mandatory ventilation. He was unconscious, with dyspnea, weak heart sounds and hepatomegaly. Moist crackles were present throughout his left lung, while the breath sounds in the right lung were decreased. After high-frequency oscillatory ventilation, empiric antimicrobials (meropenem and vancomycin), improved circulation, and right pleural cavity drainage for right pneumothorax (approximately 90% compression), his oxygen saturation level stayed above 95%, and recruitment of the right lung was observed. His condition did not deteriorate until the 5th day of hospitalization (DOH 5). On the morning of DOH 5, his oxygen saturation decreased. Subsequent chest radiograph showed bilateral pneumothorax with nearly 100% compression of the left lung. Desaturation was not relieved after urgent left pleural cavity drainage, and cardiac arrest occurred soon thereafter. Although his spontaneous heartbeat returned through emergency resuscitation and salvage antibacterial therapy (linezolid and levofloxacin) was administered given the detection and antimicrobial susceptibility of MRSA, he showed no improvement, with recurrent pyopneumothorax and continued drainage of purulent fluid and necrotic lung tissue fragments from the pleural cavity. Eventually, his parents refused extracorporeal membrane oxygenation (ECMO) and gave up all the treatments, and the newborn passed away soon after withdrawal on DOH 13. CONCLUSION Neonatal MRSA pneumonia can be refractory and lethal, especially in cases where necrotizing pneumonia leads to extensive lung necrosis and recurrent pneumothorax. Despite treatment with linezolid and other medical measures, it may still be ineffective. Currently, ECMO has been a remedial therapy, but if the lung tissue is too severely eroded to be repaired, it may be useless unless the infection can be controlled and lung transplantation can be performed. Regardless of whether ECMO is initiated, the key to successful treatment is to achieve control over the pneumonia caused by MRSA as soon as possible and to reverse lung injury as much as possible.
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Affiliation(s)
- Xing-Chao Li
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
- Institute of Pediatric Research, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
- Institute of Pediatric Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
| | - Li Sun
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
| | - Tao Li
- Department of Pediatrics, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
- Institute of Pediatric Research, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
- Institute of Pediatric Research, Taihe Hospital, Hubei University of Medicine, Shiyan 442000, Hubei Province, China
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Levy L, Deri O, Huszti E, Nachum E, Ledot S, Shimoni N, Saute M, Sternik L, Kremer R, Kassif Y, Zeitlin N, Frogel J, Lambrikov I, Matskovski I, Chatterji S, Seluk L, Furie N, Shafran I, Mass R, Onn A, Raanani E, Grinberg A, Levy Y, Afek A, Kreiss Y, Kogan A. Timing of Lung Transplant Referral in Patients with Severe COVID-19 Lung Injury Supported by ECMO. J Clin Med 2023; 12:4041. [PMID: 37373734 DOI: 10.3390/jcm12124041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 05/24/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
Severe respiratory failure caused by COVID-19 often requires mechanical ventilation, including extracorporeal membrane oxygenation (ECMO). In rare cases, lung transplantation (LTx) may be considered as a last resort. However, uncertainties remain about patient selection and optimal timing for referral and listing. This retrospective study analyzed patients with severe COVID-19 who were supported by veno-venous ECMO and listed for LTx between July 2020 and June 2022. Out of the 20 patients in the study population, four who underwent LTx were excluded. The clinical characteristics of the remaining 16 patients were compared, including nine who recovered and seven who died while awaiting LTx. The median duration from hospitalization to listing was 85.5 days, and the median duration on the waitlist was 25.5 days. Younger age was significantly associated with a higher likelihood of recovery without LTx after a median of 59 days on ECMO, compared to those who died at a median of 99 days. In patients with severe COVID-19-induced lung damage supported by ECMO, referral to LTx should be delayed for 8-10 weeks after ECMO initiation, particularly for younger patients who have a higher probability of spontaneous recovery and may not require LTx.
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Affiliation(s)
- Liran Levy
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ofir Deri
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ella Huszti
- Biostatistics Research Unit, University Health Network, Toronto, ON M5G 1X6, Canada
| | - Eyal Nachum
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Stephane Ledot
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Nir Shimoni
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Milton Saute
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Thoracic Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Leonid Sternik
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ran Kremer
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Thoracic Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yigal Kassif
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Nona Zeitlin
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Thoracic Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Jonathan Frogel
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ilya Lambrikov
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ilia Matskovski
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Anesthesiology, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Sumit Chatterji
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Lior Seluk
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Nadav Furie
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Inbal Shafran
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ronen Mass
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Amir Onn
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Institute of Pulmonary Medicine, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Ehud Raanani
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Amir Grinberg
- General Management, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yuval Levy
- General Management, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Arnon Afek
- General Management, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Yitshak Kreiss
- General Management, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Alexander Kogan
- The Sheba Lung Transplant Program, Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Department of Cardiac Surgery, Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
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8
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Camporota L, Sanderson B, Worrall S, Ostermann M, Barrett NA, Retter A, Busana M, Collins P, Romitti F, Hunt BJ, Rose L, Gattinoni L, Chiumello D. Relationship between D-dimers and dead-space on disease severity and mortality in COVID-19 acute respiratory distress syndrome: A retrospective observational cohort study. J Crit Care 2023; 77:154313. [PMID: 37116437 PMCID: PMC10129848 DOI: 10.1016/j.jcrc.2023.154313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/13/2023] [Accepted: 04/11/2023] [Indexed: 04/30/2023]
Abstract
BACKGROUND Despite its diagnostic and prognostic importance, physiologic dead space fraction is not included in the current ARDS definition or severity classification. ARDS caused by COVID-19 (C-ARDS) is characterized by increased physiologic dead space fraction and hypoxemia. Our aim was to investigate the relationship between dead space indices, markers of inflammation, immunothrombosis, severity and intensive care unit (ICU) mortality. RESULTS Retrospective data including demographics, gas exchange, ventilatory parameters, and respiratory mechanics in the first 24 h of invasive ventilation. Plasma concentrations of D-dimers and ferritin were not significantly different across C-ARDS severity categories. Weak relationships were found between D-dimers and VR (r = 0.07, p = 0.13), PETCO2/PaCO2 (r = -0.1, p = 0.02), or estimated dead space fraction (r = 0.019, p = 0.68). Age, PaO2/FiO2, pH, PETCO2/PaCO2 and ferritin, were independently associated with ICU mortality. We found no association between D-dimers or ferritin and any dead-space indices adjusting for PaO2/FiO2, days of ventilation, tidal volume, and respiratory system compliance. CONCLUSIONS We report no association between dead space and inflammatory markers in mechanically ventilated patients with C-ARDS. Our results support theories suggesting that multiple mechanisms, in addition to immunothrombosis, play a role in the pathophysiology of respiratory failure and degree of dead space in C-ARDS.
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Affiliation(s)
- Luigi Camporota
- Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London SE1 7EH, UK; Centre of Human Applied Physiological Sciences, King's College London, London, UK
| | - Barnaby Sanderson
- Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London SE1 7EH, UK
| | - Stephanie Worrall
- Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London SE1 7EH, UK
| | - Marlies Ostermann
- Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London SE1 7EH, UK
| | - Nicholas A Barrett
- Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London SE1 7EH, UK
| | - Andrew Retter
- Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London SE1 7EH, UK
| | - Mattia Busana
- Department of Anesthesiology, University Medical Center of Göttingen, Germany
| | - Patrick Collins
- Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London SE1 7EH, UK
| | - Federica Romitti
- Department of Anesthesiology, University Medical Center of Göttingen, Germany
| | - Beverley J Hunt
- Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London SE1 7EH, UK
| | - Louise Rose
- Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London SE1 7EH, UK; Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Luciano Gattinoni
- Department of Anesthesiology, University Medical Center of Göttingen, Germany
| | - Davide Chiumello
- Department of Anesthesiology and Intensive Care, ASST Santi e Paolo Hospital, University of Milan, Italy.
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9
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Commentary on "Lung Transplantation for COVID-19 Pulmonary Sequelae": Beautiful Story, Already History? Transplantation 2023; 107:305-306. [PMID: 36476617 PMCID: PMC9875793 DOI: 10.1097/tp.0000000000004415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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Jefferson T, Spencer EA, Conly JM, Rosca EC, Maltoni S, Brassey J, Onakpoya IJ, Evans DH, Heneghan CJ, Plüddemann A. Viral cultures, cycle threshold values and viral load estimation for assessing SARS-CoV-2 infectiousness in haematopoietic stem cell and solid organ transplant patients: a systematic review. J Hosp Infect 2023; 132:62-72. [PMID: 36473552 PMCID: PMC9721162 DOI: 10.1016/j.jhin.2022.11.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 11/24/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Solid organ and haematopoietic stem cell transplant recipients are more vulnerable to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) than non-transplant recipients due to immunosuppression, and may pose a continued transmission risk, especially within hospital settings. Detailed case reports including symptoms, viral load and infectiousness, defined by the presence of replication-competent viruses in culture, provide an opportunity to examine the relationship between clinical course, burden and contagiousness, and provide guidance on release from isolation. OBJECTIVES To investigate the relationship between serial SARS-CoV-2 reverse transcription polymerase chain reaction (RT-PCR) cycle threshold (Ct) value or cycle of quantification value, or other measures of viral burden and the likelihood and duration of the presence of infectious virus based on viral culture, including the influence of age, sex, underlying pathologies, degree of immunosuppression, and/or vaccination on this relationship, in transplant recipients. METHODS LitCovid, medRxiv, Google Scholar and the World Health Organization COVID-19 database were searched from 1st November 2019 to 26th October 2022. Studies reporting relevant data (results from serial RT-PCR testing and viral culture data from the same respiratory samples) for transplant recipients with SARS-CoV-2 infection were included in this systematic review: Methodological quality was assessed using five criteria, and the data were synthesized narratively and graphically. RESULTS Thirteen case reports and case series reporting on 41 transplant recipients (22 renal, five cardiac, one bone marrow, two liver, one bilateral lung and 10 blood stem cell) were included in this review. A relationship was observed between proxies of viral burden and likelihood of shedding replication-competent SARS-CoV-2. Three individuals shed replication-competent viruses for >100 days after symptom onset. Lack of standardization of testing and reporting platforms precludes establishing a definitive viral burden cut-off. However, the majority of transplant recipients stopped shedding replication-competent viruses when the Ct value was >30 despite differences across platforms. CONCLUSIONS Viral burden is a reasonable proxy for infectivity when considered within the context of the clinical status of each patient. Standardized study design and reporting are essential to standardize guidance based on an increasing evidence base.
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Affiliation(s)
- T Jefferson
- Department for Continuing Education, University of Oxford, Oxford, UK
| | - E A Spencer
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - J M Conly
- Departments of Medicine, Microbiology, Immunology & Infectious Diseases, and Pathology & Laboratory Medicine, Synder Institute for Chronic Diseases and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada
| | - E C Rosca
- Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - S Maltoni
- Division of Research and Innovation, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - I J Onakpoya
- Department for Continuing Education, University of Oxford, Oxford, UK
| | - D H Evans
- Li Ka Shing Institute of Virology and Department of Medical Microbiology & Immunology, University of Alberta, Edmonton, Canada
| | - C J Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - A Plüddemann
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
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11
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Martin AK, Feinman JW, Bhatt HV, Fritz AV, Subramani S, Malhotra AK, Townsley MM, Sharma A, Patel SJ, Ha B, Gui JL, Zaky A, Labe S, Teixeira MT, Morozowich ST, Weiner MM, Ramakrishna H. The Year in Cardiothoracic and Vascular Anesthesia: Selected Highlights from 2022. J Cardiothorac Vasc Anesth 2023; 37:201-213. [PMID: 36437141 DOI: 10.1053/j.jvca.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/09/2022]
Abstract
This special article is the 15th in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief Dr. Kaplan and the editorial board for the opportunity to continue this series, namely the research highlights of the past year in the specialties of cardiothoracic and vascular anesthesiology. The major themes selected for 2022 are outlined in this introduction, and each highlight is reviewed in detail in the main body of the article. The literature highlights, in the specialties for 2022, begin with an update on COVID-19 therapies, with a focus on the temporal updates in a wide range of therapies, progressing from medical to the use of extracorporeal membrane oxygenation and, ultimately, with lung transplantation in this high-risk group. The second major theme is focused on medical cardiology, with the authors discussing new insights into the life cycle of coronary disease, heart failure treatments, and outcomes related to novel statin therapy. The third theme is focused on mechanical circulatory support, with discussions focusing on both right-sided and left-sided temporary support outcomes and the optimal timing of deployment. The fourth and final theme is an update on cardiac surgery, with a discussion of the diverse aspects of concomitant valvular surgery and the optimal approach to procedural treatment for coronary artery disease. The themes selected for this 15th special article are only a few of the diverse advances in the specialties during 2022. These highlights will inform the reader of key updates on a variety of topics, leading to the improvement of perioperative outcomes for patients with cardiothoracic and vascular disease.
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Affiliation(s)
- Archer Kilbourne Martin
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL.
| | - Jared W Feinman
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Himani V Bhatt
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ashley Virginia Fritz
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Sudhakar Subramani
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Anita K Malhotra
- Division of Cardiothoracic Anesthesiology and Critical Care, Penn State Hershey Medical Center, Hershey, PA
| | - Matthew M Townsley
- Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, AL; Bruno Pediatric Heart Center, Children's of Alabama, Birmingham, AL
| | - Archit Sharma
- Department of Anesthesiology, University of Iowa Hospitals and Clinics, Iowa City, IA
| | - Saumil J Patel
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Bao Ha
- Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Jane L Gui
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ahmed Zaky
- Department of Anesthesiology and Perioperative Medicine, The University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Shelby Labe
- Division of Cardiothoracic Anesthesiology and Critical Care, Penn State Hershey Medical Center, Hershey, PA
| | - Miguel T Teixeira
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
| | - Steven T Morozowich
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Scottsdale, AZ
| | - Menachem M Weiner
- Department of Anesthesiology, Perioperative, and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN
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12
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Razia D, Olson MT, Grief K, Walia R, Bremner RM, Smith MA, Tokman S. Hospitalized patients with irreversible lung injury from COVID-19 have higher morbidity but similar 1-year survival after lung transplant compared to hospitalized patients transplanted for restrictive lung disease. J Heart Lung Transplant 2023; 42:255-263. [PMID: 36272894 PMCID: PMC9492395 DOI: 10.1016/j.healun.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 08/22/2022] [Accepted: 09/08/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Hospitalized lung transplant (LT) recipients (LTRs) have higher post-LT morbidity and mortality than those who are well enough to wait for transplant at home. Outcomes after LT for COVID-19-associated acute respiratory distress syndrome (CARDS) may be even worse; thus, we compared post-LT outcomes between hospitalized LTRs transplanted for CARDS and those transplanted for restrictive lung disease (RLD). METHODS Between 2014 and 2021, hospitalized LTRs ≥18 years old with CARDS or RLD were included. Primary and secondary outcomes were 1-year post-LT survival and postoperative morbidity. For each patient in the CARDS group, an analysis of 1-to-1 matched patients from the RLD group was performed using logistic regression modeling. RESULTS Of 764 LTRs, 163 (21.3%) were hospitalized at the time of LT; 132 met the inclusion criteria: 11 (8.3%) were transplanted for CARDS and 121 (91.7%) for RLD. LTRs with CARDS were younger with longer pre-LT hospitalization stays and higher rates of pretransplant mechanical ventilation, dialysis, and ECMO as a bridge to transplant. A propensity-matched analysis demonstrated comparable rates of intrathoracic adhesions, posttransplant duration of mechanical ventilation, PGD3 at 72 hours, and delayed chest closure. Compared to LTRs with RLD, those with CARDS had significantly longer posttransplant hospital stays and a higher prevalence of ACR ≥A2 and DSA >2000 MFI, but comparable 1-year survival rates. CONCLUSION Even with careful selection, LT for patients with CARDS was associated with significant morbidity; however, 1-year survival of recipients with CARDS was comparable to that of matched hospitalized recipients with RLD.
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Affiliation(s)
- Deepika Razia
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Michael T. Olson
- University of Arizona College of Medicine – Phoenix Campus, Phoenix, Arizona, USA
| | - Katherine Grief
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona
| | - Rajat Walia
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona,Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
| | - Ross M. Bremner
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona,Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
| | - Michael A. Smith
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona,Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona
| | - Sofya Tokman
- Norton Thoracic Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona; Creighton University School of Medicine, Phoenix Regional Campus, Phoenix, Arizona.
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13
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Kim SA, Yun JK, Lee GD, Kim DK, Choi S. Early Outcomes of COVID-19 Lung Transplantation Recipients in Korea: A Single-Center Study. J Chest Surg 2023; 56:6-13. [PMID: 36476445 PMCID: PMC9845857 DOI: 10.5090/jcs.22.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 09/26/2022] [Accepted: 10/23/2022] [Indexed: 12/12/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) has been found to cause life-threatening respiratory failure, which can progress to irreversible lung damage. Lung transplantation can be a life-saving treatment in patients with terminal lung disease (e.g., acute respiratory distress syndrome caused by infection). This study aimed to present the clinical course and results after initial lung transplantation in patients with severe COVID-19 who did not recover even with optimal medical care. Methods From August 2019 to February 2022, this study enrolled 10 patients with COVID-19 (5 men; median age, 55.7 years) who underwent lung transplantation at a single center in Korea. All patients' characteristics, clinical pathway, overall survival, complications, and operative data were collected and analyzed. Results Veno-venous extracorporeal membrane oxygenation or an oxygenator in a right ventricular assist device circuit was applied to 90% of the patients, and the median length of extracorporeal life support before operation was 48.5 days. There were no cases of mortality after a median follow-up of 372.8 days (interquartile range, 262.25-489 days). The major complications included the requirement for postoperative extracorporeal membrane oxygenation support in 2 cases (20%), re-transplantation in 1 case (10%), and re-exploration due to bleeding in 2 cases (20%). During the follow-up period, 3 out of 10 patients died. Conclusion Excellent early outcomes were observed for patients who underwent lung transplantation. Thus, lung transplantation can be an effective and feasible treatment for patients with end-stage lung disease caused by COVID-19.
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Affiliation(s)
- Shi A Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Geun Dong Lee
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sehoon Choi
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea,Corresponding author Sehoon Choi Tel 82-2-3010-3580 Fax 82-2-3010-6966 E-mailORCIDhttps://orcid.org/0000-0002-9961-9289 See Commentary page 14
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14
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Lee JG. Commentary: Referral for Lung Transplantation Should Be Carefully Decided for Patients with COVID-19 Acute Respiratory Distress Syndrome. J Chest Surg 2023; 56:14-15. [PMID: 36598119 PMCID: PMC9845853 DOI: 10.5090/jcs.22.159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 12/28/2022] [Indexed: 01/05/2023] Open
Affiliation(s)
- Jin Gu Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea,Corresponding author Jin Gu Lee Tel 82-2-2228-2140, Fax 82-2-393-6012, E-mail, ORCIDhttps://orcid.org/0000-0003-2767-6505
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15
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Weder MM, Aslam S, Ison MG. Lung Transplantation for COVID-19-related Lung Disease: Clinical Experience and Call for a Global Registry. Transplantation 2023; 107:18-20. [PMID: 35969003 PMCID: PMC9746226 DOI: 10.1097/tp.0000000000004327] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/13/2022] [Accepted: 07/19/2022] [Indexed: 02/07/2023]
Affiliation(s)
- Max M. Weder
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA
| | - Saima Aslam
- Division of Infectious Diseases and Global Public Health, University of California San Diego, La Jolla, CA
| | - Michael G. Ison
- Divisions of Infectious Diseases and Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL
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16
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Hartwig M, van Berkel V, Bharat A, Cypel M, Date H, Erasmus M, Hoetzenecker K, Klepetko W, Kon Z, Kukreja J, Machuca T, McCurry K, Mercier O, Opitz I, Puri V, Van Raemdonck D. The American Association for Thoracic Surgery (AATS) 2022 Expert Consensus Document: The use of mechanical circulatory support in lung transplantation. J Thorac Cardiovasc Surg 2023; 165:301-326. [PMID: 36517135 DOI: 10.1016/j.jtcvs.2022.06.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/26/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The use of mechanical circulatory support (MCS) in lung transplantation has been steadily increasing over the prior decade, with evolving strategies for incorporating support in the preoperative, intraoperative, and postoperative settings. There is significant practice variability in the use of these techniques, however, and relatively limited data to help establish institutional protocols. The objective of the AATS Clinical Practice Standards Committee (CPSC) expert panel was to review the existing literature and establish recommendations about the use of MCS before, during, and after lung transplantation. METHODS The AATS CPSC assembled an expert panel of 16 lung transplantation physicians who developed a consensus document of recommendations. The panel was broken into subgroups focused on preoperative, intraoperative, and postoperative support, and each subgroup performed a focused literature review. These subgroups formulated recommendation statements for each subtopic, which were evaluated by the entire group. The statements were then developed via discussion among the panel and refined until consensus was achieved on each statement. RESULTS The expert panel achieved consensus on 36 recommendations for how and when to use MCS in lung transplantation. These recommendations included the use of veno-venous extracorporeal membrane oxygenation (ECMO) as a bridging strategy in the preoperative setting, a preference for central veno-arterial ECMO over traditional cardiopulmonary bypass during the transplantation procedure, and the benefit of supporting selected patients with MCS postoperatively. CONCLUSIONS Achieving optimal results in lung transplantation requires the use of a wide range of strategies. MCS provides an important mechanism for helping these critically ill patients through the peritransplantation period. Despite the complex nature of the decision making process in the treatment of these patients, the expert panel was able to achieve consensus on 36 recommendations. These recommendations should provide guidance for professionals involved in the care of end-stage lung disease patients considered for transplantation.
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Affiliation(s)
- Matthew Hartwig
- Division of Thoracic Surgery, Duke University Medical Center, Durham, NC.
| | | | | | | | - Hiroshi Date
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Michiel Erasmus
- University Academic Center Groningen, Groningen, The Netherlands
| | | | | | | | - Jasleen Kukreja
- University of California San Francisco, San Francisco, Calif
| | - Tiago Machuca
- University of Florida College of Medicine, Gainesville, Fla
| | | | - Olaf Mercier
- Université Paris-Saclay and Marie Lannelongue Hospital, Le Plessis-Robinson, France
| | | | - Varun Puri
- Washington University School of Medicine, St Louis, Mo
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17
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Jyothula SSK, Peters A, Liang Y, Bi W, Shivshankar P, Yau S, Garcha PS, Yuan X, Akkanti B, Collum S, Wareing N, Thandavarayan RA, Poli de Frias F, Rosas IO, Zhao B, Buja LM, Eltzschig HK, Huang HJ, Karmouty-Quintana H. Fulminant lung fibrosis in non-resolvable COVID-19 requiring transplantation. EBioMedicine 2022; 86:104351. [PMID: 36375315 PMCID: PMC9667270 DOI: 10.1016/j.ebiom.2022.104351] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 10/04/2022] [Accepted: 10/20/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Coronavirus Disease 2019 (COVID-19) can lead to the development of acute respiratory distress syndrome (ARDS). In some patients with non-resolvable (NR) COVID-19, lung injury can progress rapidly to the point that lung transplantation is the only viable option for survival. This fatal progression of lung injury involves a rapid fibroproliferative response and takes on average 15 weeks from initial symptom presentation. Little is known about the mechanisms that lead to this fulminant lung fibrosis (FLF) in NR-COVID-19. METHODS Using a pre-designed unbiased PCR array for fibrotic markers, we analyzed the fibrotic signature in a subset of NR-COVID-19 lungs. We compared the expression profile against control lungs (donor lungs discarded for transplantation), and explanted tissue from patients with idiopathic pulmonary fibrosis (IPF). Subsequently, RT-qPCR, Western blots and immunohistochemistry were conducted to validate and localize selected pro-fibrotic targets. A total of 23 NR-COVID-19 lungs were used for RT-qPCR validation. FINDINGS We revealed a unique fibrotic gene signature in NR-COVID-19 that is dominated by a hyper-expression of pro-fibrotic genes, including collagens and periostin. Our results also show a significantly increased expression of Collagen Triple Helix Repeat Containing 1(CTHRC1) which co-localized in areas rich in alpha smooth muscle expression, denoting myofibroblasts. We also show a significant increase in cytokeratin (KRT) 5 and 8 expressing cells adjacent to fibroblastic areas and in areas of apparent epithelial bronchiolization. INTERPRETATION Our studies may provide insights into potential cellular mechanisms that lead to a fulminant presentation of lung fibrosis in NR-COVID-19. FUNDING National Institute of Health (NIH) Grants R01HL154720, R01DK122796, R01DK109574, R01HL133900, and Department of Defense (DoD) Grant W81XWH2110032 to H.K.E. NIH Grants: R01HL138510 and R01HL157100, DoD Grant W81XWH-19-1-0007, and American Heart Association Grant: 18IPA34170220 to H.K.-Q. American Heart Association: 19CDA34660279, American Lung Association: CA-622265, Parker B. Francis Fellowship, 1UL1TR003167-01 and The Center for Clinical and Translational Sciences, McGovern Medical School to X.Y.
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Affiliation(s)
- Soma S K Jyothula
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA; Center for Advanced Cardiopulmonary Therapies and Transplantation at UTHealth/McGovern Medical School, Houston, TX, USA
| | - Andrew Peters
- Department of Biochemistry and Molecular Biology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Yafen Liang
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Weizhen Bi
- Department of Biochemistry and Molecular Biology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Pooja Shivshankar
- Department of Biochemistry and Molecular Biology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Simon Yau
- Houston Methodist DeBakey Transplant Center, Houston Methodist Hospital, Houston, TX, USA
| | - Puneet S Garcha
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Xiaoyi Yuan
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Bindu Akkanti
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA; Center for Advanced Cardiopulmonary Therapies and Transplantation at UTHealth/McGovern Medical School, Houston, TX, USA
| | - Scott Collum
- Department of Biochemistry and Molecular Biology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Nancy Wareing
- Department of Biochemistry and Molecular Biology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Fernando Poli de Frias
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Ivan O Rosas
- Department of Medicine, Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Bihong Zhao
- Department of Pathology and Laboratory Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - L Maximilian Buja
- Department of Pathology and Laboratory Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Holger K Eltzschig
- Department of Anesthesiology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Howard J Huang
- Houston Methodist DeBakey Transplant Center, Houston Methodist Hospital, Houston, TX, USA
| | - Harry Karmouty-Quintana
- Department of Internal Medicine, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA; Center for Advanced Cardiopulmonary Therapies and Transplantation at UTHealth/McGovern Medical School, Houston, TX, USA; UTHealth Pulmonary Center of Excellence, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, USA.
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18
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Munshi L, Brodie D, Fan E. Extracorporeal Support for Acute Respiratory Distress Syndrome in Adults. NEJM EVIDENCE 2022; 1:EVIDra2200128. [PMID: 38319864 DOI: 10.1056/evidra2200128] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Extracorporeal Support for ARDS in AdultsThere is a subset of patients who develop severe ARDS for whom supportive care with mechanical ventilation is insufficient or possibly injurious. The use of ECMO as an adjunct to treat these patients is reviewed.
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Affiliation(s)
- Laveena Munshi
- Interdepartmental Division of Critical Care Medicine, Sinai Health System/University Health Network, University of Toronto
- Institute of Health Policy, Management and Evaluation, University of Toronto
| | - Daniel Brodie
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York
- Center for Acute Respiratory Failure, NewYork-Presbyterian Hospital, New York
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, Sinai Health System/University Health Network, University of Toronto
- Institute of Health Policy, Management and Evaluation, University of Toronto
- Toronto General Hospital Research Institute
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19
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Lang C, Ritschl V, Augustin F, Lang G, Moser B, Taghavi S, Murakoezy G, Lambers C, Flick H, Koestenberger M, Brooks R, Muhr T, Knotzer J, Mydza D, Kaufmann M, Staudinger T, Zauner C, Krenn C, Schaden E, Bacher A, Rössler B, Faybik P, Tschernko E, Anwar M, Markstaller K, Hoefer D, Stamm T, Jaksch P, Hoetzenecker K. Clinical relevance of lung transplantation for COVID-19 ARDS: a nationwide study. Eur Respir J 2022; 60:2102404. [PMID: 35301249 PMCID: PMC8932280 DOI: 10.1183/13993003.02404-2021] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/13/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Although the number of lung transplantations (LTx) performed worldwide for coronavirus disease 2019 (COVID-19)-induced acute respiratory distress syndrome (ARDS) is still low, there is general agreement that this treatment can save a subgroup of the most severely ill patients with irreversible lung damage. However, the true proportion of patients eligible for LTx, the overall outcome and the impact of LTx on the pandemic are unknown. METHODS A retrospective analysis was performed using a nationwide registry of hospitalised patients with confirmed severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) infection admitted between 1 January 2020 and 30 May 2021 in Austria. Patients referred to one of the two Austrian LTx centres were analysed, and grouped into patients accepted and rejected for LTx. Detailed outcome analysis was performed for all patients who received a LTx for post-COVID-19 ARDS and compared with patients who underwent LTx for other indications. RESULTS Between 1 January 2020 and 30 May 2021, 39 485 patients were hospitalised for COVID-19 in Austria. 2323 required mechanical ventilation and 183 received extracorporeal membrane oxygenation (ECMO) support. 106 patients with severe COVID-19 ARDS were referred for LTx. Of these, 19 (18%) underwent LTx. 30-day mortality after LTx was 0% for COVID-19 ARDS transplant recipients. At a median follow-up of 134 (47-450) days, 14 out of 19 patients were alive. CONCLUSIONS Early referral of ECMO patients to a LTx centre is pivotal in order to select patients eligible for LTx. Transplantation offers excellent midterm outcomes and should be incorporated in the treatment algorithm of post-COVID-19 ARDS.
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Affiliation(s)
- Christian Lang
- Dept of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Florian Augustin
- Dept of Visceral, Transplant and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Gyoergy Lang
- Dept of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Bernhard Moser
- Dept of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Shahrokh Taghavi
- Dept of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | | | - Christopher Lambers
- Dept of Pneumology, Ordensklinikum Linz Elisabethinen Hospital, Linz, Austria
| | - Holger Flick
- Division of Pulmonology, Medical University of Graz, Graz, Austria
| | - Markus Koestenberger
- Dept of Anaesthesiology and Intensive Care, Klinikum Klagenfurt am Wörthersee, Klagenfurt am Wörthersee, Austria
| | - Roxane Brooks
- Intensive Care Unit 1, Clinic of Anaesthesiology and Intensive Care Medicine, Johannes Kepler University Linz, Linz, Austria
| | - Tina Muhr
- Intensive Care Unit, Division of Cardiology, Dept of Internal Medicine, State Hospital (LKH) Graz II, Graz, Austria
| | - Johann Knotzer
- Dept of Anaesthesiology and Critical Care Medicine, Klinikum Wels - Grieskirchen, Wels, Austria
| | - Daniel Mydza
- 1st Medical Dept, Klinik Favoriten, Vienna, Austria
| | - Marc Kaufmann
- Dept of Anaesthesiology and Intensive Care Unit, Bozen Central Hospital, Bozen, Italy
| | - Thomas Staudinger
- Intensive Care Unit 13i2, Dept of Internal Medicine I, Medical University of Vienna, Vienna, Austria
| | - Christian Zauner
- Intensive Care Unit 13H1, Dept of Internal Medicine III, Medical University of Vienna, Vienna, Austria
| | - Claus Krenn
- Intensive Care Unit 13C1, Dept of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Eva Schaden
- Intensive Care Unit 13C1, Dept of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Digital Health and Patient Safety (LBI-DHPS), Medical University of Vienna, Vienna, Austria
| | - Andreas Bacher
- Intensive Care Unit 13C2, Dept of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Bernhard Rössler
- Intensive Care Unit 9D, Dept of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Faybik
- Intensive Care Unit 13C3, Dept of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Edda Tschernko
- Division of Cardiac, Thoracic and Vascular Anaesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Maria Anwar
- Division of Cardiac, Thoracic and Vascular Anaesthesia and Intensive Care, Medical University of Vienna, Vienna, Austria
| | - Klaus Markstaller
- Dept of Anaesthesia, Intensive Care Medicine and Pain Medicine, Medical University of Vienna, Vienna, Austria
| | - Daniel Hoefer
- Dept of Cardiac Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
- Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Peter Jaksch
- Dept of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
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20
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Florissi IS, Etchill EW, Barbur I, Verdi KG, Merlo C, Bush EL. Lung Transplantation in Patients With COVID-19-The Early National Experience. Semin Thorac Cardiovasc Surg 2022; 35:822-830. [PMID: 36038079 PMCID: PMC9420205 DOI: 10.1053/j.semtcvs.2022.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 08/16/2022] [Indexed: 12/15/2022]
Abstract
Lung transplant (LT) has become a viable option for COVID-19 patients suffering from end-stage Acute Respiratory Distress Syndrome (ARDS). This analysis sought to describe the early national experience of COVID-19 patients who received LT and compare transplant characteristics and short-term outcomes of COVID-19 and non-COVID-19 ARDS LT recipients. We queried the Organ Procurement and Transplantation database for adults (≥18 years old) receiving LT from January 2009 to March 31, 2022 with diagnoses of COVID-19 or ARDS. We identified 353 COVID-19 and 64 non-COVID-19 ARDS LT recipients. COVID-19 recipients were older (median age: 51, interquartile range [40-57] years vs 41 [26-52]; P < 0.001), more predominantly male (78% (n = 274) vs 55% (n = 35), P < 0.001), and had higher body mass indices (median 27.2 interquartile range [24.5-30.9] vs 25.4 [22.1-28.6]; P < 0.01) than non-COVID-19 ARDS recipients. COVID-19 LT recipients were less frequently reliant on extra-corporeal membrane oxygenation at 72 hours after transplant (26% (n = 80) vs 31% (n = 15), P < 0.001), and were less frequently dependent on dialysis post-transplant than non-COVID-19 ARDS LT recipients (14% (n = 43) vs 23% (n = 14); P = 0.01). Survival at 90 days post-transplant was comparable for the non-COVID ARDS (90%, n = 54) and COVID-19 (94%, n = 202) LT recipients with available follow-up (P = 0.17). LT appears to be a viable therapy for COVID-19 patients with end-stage lung disease. COVID-19 LT and non-COVID-19 ARDS LT recipients have comparable 90 days post-transplant survival.
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Affiliation(s)
- Isabella S Florissi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric W Etchill
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Iulia Barbur
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Katherine G Verdi
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Christian Merlo
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Errol L Bush
- Division of Thoracic Surgery, Johns Hopkins Hospital, Baltimore, Maryland.
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21
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Lung Transplant for ARDS after COVID-19: Long-Term Outcomes and Considerations about Detrimental Issues. J Clin Med 2022; 11:jcm11164754. [PMID: 36012993 PMCID: PMC9409702 DOI: 10.3390/jcm11164754] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 11/16/2022] Open
Abstract
During the first outbreak of COVID-19 in Italy, based on the only few cases reported from a Chinese centre at the time, we performed lung transplantation in two patients with irreversible acute respiratory distress syndrome (ARDS) after COVID-19 at our centre. After two years, we report the outcomes of these cases and some considerations. The first patient, an 18-year-old male, is in excellent conditions twenty-four months after surgery. The second patient was a 48-year-old man; his airways were colonized by carbapenemase-producing klebsiella pneumoniae at the time of lung transplantation, and he had previously suffered from delirium and hallucinations in the intensive care unit. His postoperative clinical course was complicated by dysexecutive behaviour and then septic shock; he died 62 days after surgery. The recently reported experience of different transplantation centres has led to the inclusion of irreversible acute respiratory distress syndrome (ARDS) after COVID-19 among the indications for lung transplantation in carefully selected patients. Our results confirm the feasibility and the good long-term outcomes of lung transplantation for COVID-19-associated ARDS. Nonetheless, our experience corroborates the need for careful recipient selection: special attention must be paid to the single-organ dysfunction principle, the evaluation of any neuro-psychiatric disorder, and MDR germs colonization, before listing.
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22
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Cho WH. Lung Transplantation for Patients with COVID-19 Acute Respiratory Distress Syndrome. J Chest Surg 2022; 55:357-360. [PMID: 35924544 PMCID: PMC9358166 DOI: 10.5090/jcs.22.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022] Open
Abstract
Patients with severe coronavirus disease 2019 (COVID-19) acute respiratory distress syndrome (ARDS) may exhibit pulmonary fibrosis after the viral illness resolves. Some of these patients may experience severe functional lung impairment, and thus require transplants to prevent death or maintain a tolerable quality of life. Considering the reversibility of COVID-19 ARDS, lung transplant candidates are observed for 1–2 months and must be selected very carefully before transplantation. As the short-term outcomes of such patients are comparable to those of patients with other indications for transplantation, lung transplantation should be actively considered.
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Affiliation(s)
- Woo Hyun Cho
- Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
- Division of Allergy, Pulmonary and Critical Care Medicine, Department of Internal Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
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23
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Haslbauer JD, Bratic-Hench I, Cima K, Luger AK, Schmitz K, Augustin F, Krapf C, Hoefer D, Tancevski I, Tzankov A, Löffler-Ragg J. Interstitial Pulmonary Fibrosis and Extensive Dendriform Ossification with Persistent Viral Load: A Rare Presentation of Post-COVID-19 Condition in Need of Lung Transplantation. Pathobiology 2022; 90:138-146. [PMID: 35835004 PMCID: PMC10129030 DOI: 10.1159/000525457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/04/2022] [Indexed: 11/19/2022] Open
Abstract
The incidence, presentation, and predisposing factors of post-acute sequelae of COVID-19 (PASC) are currently poorly understood. Lung explants may provide a rare insight into terminal SARS-CoV-2-associated lung damage and its pathophysiology. A 62-year-old man presented with progressively worsening respiratory symptoms after recovering from mild COVID-19 3 months earlier. No underlying pulmonary comorbidities were reported. A chest CT revealed bilateral extensive ground-glass and reticular opacities, suspicious of pulmonary fibrosis. Despite initial high-dose glucocorticoid therapy, the interstitial lung disease progressed, and after exhausting all viable therapeutic options, bilateral lung transplantation was successfully conducted. Histological analysis revealed extensive end-stage interstitial fibrosis with diffuse dendriform ossification and bronchiolar and transitional cell metaplasia. Signs of interstitial remodeling such as an increased interstitial collagen deposition, a pathological accumulation of CD163+/CD206+ M2-polarized macrophages with an increased expression of phosphorylated ERK, and an increased density of CD105+ newly formed capillaries were observed. qRT-PCR and immunohistochemistry for SARS-CoV-2 N-protein in the endothelium of medium-sized vessels confirmed a persistence of SARS-CoV-2. Our findings highlight a highly unusual presentation of SARS-CoV-2-associated lung fibrosis, implying that incomplete viral clearance in the vascular compartment may play a vital pathophysiological role in the development of PASC.
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Affiliation(s)
- Jasmin Dionne Haslbauer
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland,
| | - Ivana Bratic-Hench
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Katharina Cima
- Department of Internal Medicine II (Infectiology, Rheumatology, Pneumology), Medical University of Innsbruck, Innsbruck, Austria
| | | | - Katja Schmitz
- Institute of Pathology, Innpath, Tyrolean State Clinics, Innsbruck, Austria
| | - Florian Augustin
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Krapf
- Department of Thoracic and Cardiovascular Surgery, University Hospital Innsbruck, Innsbruck, Austria
| | - Daniel Hoefer
- Department of Thoracic and Cardiovascular Surgery, University Hospital Innsbruck, Innsbruck, Austria
| | - Ivan Tancevski
- Department of Internal Medicine II (Infectiology, Rheumatology, Pneumology), Medical University of Innsbruck, Innsbruck, Austria
| | - Alexandar Tzankov
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Judith Löffler-Ragg
- Department of Internal Medicine II (Infectiology, Rheumatology, Pneumology), Medical University of Innsbruck, Innsbruck, Austria
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24
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Nimmo A, Gardiner D, Ushiro-Lumb I, Ravanan R, Forsythe JLR. The Global Impact of COVID-19 on Solid Organ Transplantation: Two Years Into a Pandemic. Transplantation 2022; 106:1312-1329. [PMID: 35404911 PMCID: PMC9213067 DOI: 10.1097/tp.0000000000004151] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 02/06/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had a major global impact on solid organ transplantation (SOT). An estimated 16% global reduction in transplant activity occurred over the course of 2020, most markedly impacting kidney transplant and living donor programs, resulting in substantial knock-on effects for waitlisted patients. The increased severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection risk and excess deaths in transplant candidates has resulted in substantial effort to prioritize the safe restart and continuation of transplant programs over the second year of the pandemic, with transplant rates returning towards prepandemic levels. Over the past 2 y, COVID-19 mortality in SOT recipients has fallen from 20%-25% to 8%-10%, attributed to the increased and early availability of SARS-CoV-2 testing, adherence to nonpharmaceutical interventions, development of novel treatments, and vaccination. Despite these positive steps, transplant programs and SOT recipients continue to face challenges. Vaccine efficacy in SOT recipients is substantially lower than the general population and SOT recipients remain at an increased risk of adverse outcomes if they develop COVID-19. SOT recipients and transplant teams need to remain vigilant and ongoing adherence to nonpharmaceutical interventions appears essential. In this review, we summarize the global impact of COVID-19 on transplant activity, donor evaluation, and patient outcomes over the past 2 y, discuss the current strategies aimed at preventing and treating SARS-CoV-2 infection in SOT recipients, and based on lessons learnt from this pandemic, propose steps the transplant community could consider as preparation for future pandemics.
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Affiliation(s)
- Ailish Nimmo
- Renal Department, Southmead Hospital, North Bristol NHS Trust, Bristol, United Kingdom
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25
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Tsuang WM, MacMurdo M, Curtis J. Application of Place-Based Methods to Lung Transplant Medicine. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:7355. [PMID: 35742599 PMCID: PMC9223451 DOI: 10.3390/ijerph19127355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/08/2022] [Accepted: 06/13/2022] [Indexed: 02/05/2023]
Abstract
Lung transplantation is an increasingly common lifesaving therapy for patients with fatal lung diseases, but this intervention has a critical limitation as median survival after LT is merely 5.5 years. Despite the profound impact of place-based factors on lung health, this has not been rigorously investigated in LT recipients-a vulnerable population due to the lifelong need for daily life-sustaining immunosuppression medications. There have also been longstanding methodological gaps in transplant medicine where both time and place have not been measured; gaps which could be filled by the geospatial sciences. As part of an exploratory analysis, we studied recipients transplanted at our center over a two-year period. The main outcome was at least one episode of rejection within the first year after transplant. We found recipients averaged 1.7 unique residential addresses, a modest relocation rate. Lung rejection was associated with census tracts of predominantly underrepresented minorities or where English was not the primary language as measured by the social vulnerability index. Census tracts likely play an important role in measuring and addressing geographic disparities in transplantation. In a future paradigm, patient spatial data could become an integrated part of real time clinical care to aid in personalized risk stratification and personalized delivery of healthcare.
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Affiliation(s)
- Wayne M. Tsuang
- Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA;
| | - Maeve MacMurdo
- Respiratory Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA;
| | - Jacqueline Curtis
- GIS Health & Hazards Lab, Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH 44106, USA;
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26
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Yehuda R, Joshua L, Rodrigo V, Ramona NR. Personal Protective Equipment for Liver Transplantation in SARS-CoV-2 Polymerase Chain Reaction-Positive Convalescing Recipients. Transplant Proc 2022; 54:1528-1533. [PMID: 35871876 PMCID: PMC9157021 DOI: 10.1016/j.transproceed.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 11/09/2022]
Abstract
Personal protective equipment (PPE) comes in several variations, and is the principal safety gear during the COVID-19 pandemic. Unfortunately, the user is severely impacted by its serious nonergonomic features. What PPE is appropriate for labor-intensive cases, like liver transplant (LT), remains unknown. We describe our experience with 2 types of PPE used during 2 separate LT performed in COVID-19 positive recipients. We conclude that for the safety of both health care workers and patients, hospitals should designate a few PPE kits for labor-intensive surgical procedures. These kits should include powered air-purifying respirators, or a similar loose-fitting powered air hood.
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27
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Bartelt L, van Duin D. An overview of COVID-19 in solid organ transplantation. Clin Microbiol Infect 2022; 28:779-784. [PMID: 35189336 PMCID: PMC8855607 DOI: 10.1016/j.cmi.2022.02.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The COVID-19 pandemic has influenced the field of solid organ transplantation (SOT) in many ways. COVID-19 has led to programmatic impacts and changes in donor and recipient selection. Several studies have evaluated the course, optimal treatment, and prevention of COVID-19 in SOT recipients. OBJECTIVES To review the literature on COVID-19 in SOT recipients. SOURCES PubMed, Web of Science, and Google Scholar were searched. The search was restricted to articles published between January 1, 2019 and December 1, 2021. CONTENT The COVID-19 pandemic initially led to a decreased volume of solid organ transplants. However, transplant volumes at most centres have rebounded. Donor selection remains an incompletely defined issue. Several reports suggest that donor-derived SARS-CoV-2 infections occur only in lung transplant recipients and that other organs from SARS-CoV-2 PCR-positive donors could potentially be safely used. However, these data are limited to case series. Transplantation for end-stage lung disease after COVID-19 infection is increasingly common and has been performed with acceptable outcomes. In acute COVID-19 in a transplant candidate, transplantation should be delayed when feasible. After adjustment, mortality after COVID-19 appear similar in SOT recipients compared to the general population, with notable increased use of antiviral and anti-inflammatory treatment options. Prevention of COVID-19 is key in SOT recipients. Vaccination of SOT recipients and anyone who is in contact with SOT recipients is one of the cornerstones of prevention. Nonpharmacological interventions such as face coverings, hand hygiene, and physical distancing remain ever important as well. IMPLICATIONS The COVID-19 pandemic continues to have an important impact on SOT candidates and recipients. Prevention of infection is the most important measure and requires careful attention to approaches to vaccination and messaging of the ongoing need for face coverings, physical distancing, and hand hygiene.
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Affiliation(s)
- Luther Bartelt
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, North Carolina, USA
| | - David van Duin
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA.
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28
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Sreenivasan J, Ranka S, Lahan S, Abu-Haniyeh A, Li H, Kaul R, Malik A, Aronow WS, Frishman WH, Lansman S. Extracorporeal Membrane Oxygenation in Patients With COVID-19. Cardiol Rev 2022; 30:129-133. [PMID: 34292184 PMCID: PMC8983617 DOI: 10.1097/crd.0000000000000410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Coronavirus disease 2019 (COVID-19) is characterized by a clinical spectrum of diseases ranging from asymptomatic or mild cases to severe pneumonia with acute respiratory distress syndrome (ARDS) requiring mechanical ventilation. Extracorporeal membrane oxygenation (ECMO) has been used as rescue therapy in appropriate patients with COVID-19 complicated by ARDS refractory to mechanical ventilation. In this study, we review the indications, challenges, complications, and clinical outcomes of ECMO utilization in critically ill patients with COVID-19-related ARDS. Most of these patients required venovenous ECMO. Although the risk of mortality and complications is very high among patients with COVID-19 requiring ECMO, it is similar to that of non-COVID-19 patients with ARDS requiring ECMO. ECMO is a resource-intensive therapy, with an inherent risk of complications, which makes its availability limited and its use challenging in the midst of a pandemic. Well-maintained data registries, with timely reporting of outcomes and evidence-based clinical guidelines, are necessary for the careful allocation of resources and for the development of standardized utilization protocols.
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Affiliation(s)
- Jayakumar Sreenivasan
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Sagar Ranka
- Department of Cardiovascular Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Shubham Lahan
- University College of Medical Sciences, New Delhi, India
| | - Ahmed Abu-Haniyeh
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Heyi Li
- Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Risheek Kaul
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Aaqib Malik
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Wilbert S. Aronow
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - William H. Frishman
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Steven Lansman
- From the Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
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Olschewski H, Eber E, Bucher B, Hackner K, Handzhiev S, Hoetzenecker K, Idzko M, Klepetko W, Kovacs G, Lamprecht B, Löffler-Ragg J, Meilinger M, Müller A, Prior C, Schindler O, Täubl H, Zacharasiewicz A, Zwick RH, Arns BM, Bolitschek J, Cima K, Gingrich E, Hochmair M, Horak F, Jaksch P, Kropfmüller R, Pfleger A, Puchner B, Puelacher C, Rodriguez P, Salzer HJF, Schenk P, Stelzmüller I, Strenger V, Urban M, Wagner M, Wimberger F, Flick H. Management of patients with SARS-CoV-2 infections with focus on patients with chronic lung diseases (as of 10 January 2022) : Updated statement of the Austrian Society of Pneumology (ASP). Wien Klin Wochenschr 2022; 134:399-419. [PMID: 35449467 PMCID: PMC9022736 DOI: 10.1007/s00508-022-02018-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 02/17/2022] [Indexed: 12/15/2022]
Abstract
The Austrian Society of Pneumology (ASP) launched a first statement on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in May 2020, at a time when in Austria 285 people had died from this disease and vaccinations were not available. Lockdown and social distancing were the only available measures to prevent more infections and the breakdown of the health system. Meanwhile, in Austria over 13,000 patients have died in association with a SARS-CoV‑2 infection and coronavirus disease 2019 (COVID-19) was among the most common causes of death; however, SARS-CoV‑2 has been mutating all the time and currently, most patients have been affected by the delta variant where the vaccination is very effective but the omicron variant is rapidly rising and becoming predominant. Particularly in children and young adults, where the vaccination rate is low, the omicron variant is expected to spread very fast. This poses a particular threat to unvaccinated people who are at elevated risk of severe COVID-19 disease but also to people with an active vaccination. There are few publications that comprehensively addressed the special issues with SARS-CoV‑2 infection in patients with chronic lung diseases. These were the reasons for this updated statement. Pulmonologists care for many patients with an elevated risk of death in case of COVID-19 but also for patients that might be at an elevated risk of vaccination reactions or vaccination failure. In addition, lung function tests, bronchoscopy, respiratory physiotherapy and training therapy may put both patients and health professionals at an increased risk of infection. The working circles of the ASP have provided statements concerning these risks and how to avoid risks for the patients.
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Affiliation(s)
- Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria.
| | - Ernst Eber
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Brigitte Bucher
- Department of Pulmonology, Tirol Kliniken, Hospital Hochzirl-Natters, Natters, Austria
| | - Klaus Hackner
- Department of Pneumology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Sabin Handzhiev
- Department of Pneumology, University Hospital Krems, Karl Landsteiner University of Health Sciences, Krems, Austria
| | - Konrad Hoetzenecker
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Marco Idzko
- Division of Pulmonology, Department of Medicine II, Medical University of Vienna, Vienna, Austria
| | - Walter Klepetko
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Gabor Kovacs
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Bernd Lamprecht
- Department of Pulmonology, Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
| | - Judith Löffler-Ragg
- Pulmonology, Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria
| | - Michael Meilinger
- Department of Internal Medicine and Pulmonology, Klinik Floridsdorf, Vienna, Austria
| | - Alexander Müller
- Department of Physical Medicine and Rehabilitation, Klinik Floridsdorf, Vienna, Austria
| | | | - Otmar Schindler
- Department of Internal and Respiratory Medicine, Hospital Graz II, Hospital Enzenbach, Gratwein, Austria
| | - Helmut Täubl
- Department of Pulmonology, Tirol Kliniken, Hospital Hochzirl-Natters, Natters, Austria
| | | | - Ralf Harun Zwick
- Outpatient Pulmonary Rehabilitation, Therme Wien Med, Vienna, Austria
| | | | - Josef Bolitschek
- Department of Pneumology, Ordensklinikum Linz Elisabethinen Hospital, Linz, Austria
| | - Katharina Cima
- Department of Pulmonology, Tirol Kliniken, Hospital Hochzirl-Natters, Natters, Austria
| | | | - Maximilian Hochmair
- Department of Respiratory and Critical Care Medicine, Karl Landsteiner Institute of Lung Research and Pulmonary Oncology, Klinik Floridsdorf, Vienna, Austria
| | | | - Peter Jaksch
- Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria
| | - Roland Kropfmüller
- Department of Pulmonology, Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
| | - Andreas Pfleger
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Bernhard Puchner
- Department of Pulmonology, Reha Zentrum Münster, Münster, Austria
| | | | - Patricia Rodriguez
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Helmut J F Salzer
- Department of Pulmonology, Faculty of Medicine, Johannes-Kepler-University, Linz, Austria
| | - Peter Schenk
- Department of Pulmonology, Landesklinikum Hochegg, Grimmenstein, Austria
| | | | - Volker Strenger
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Matthias Urban
- Department of Internal Medicine and Pulmonology, Klinik Floridsdorf, Vienna, Austria
| | - Marlies Wagner
- Division of Paediatric Pulmonology and Allergology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Franz Wimberger
- Department of Pneumology, Ordensklinikum Linz Elisabethinen Hospital, Linz, Austria
| | - Holger Flick
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
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Shah U, Rahulan V, Srinivas R, Kumar S, Anoop Mohandas K, Kori S, Panda S, Singh V, Kumar P, Prasanna G, Satish Rao I, Kalle A, Manish D, John PA, Mahesh B, Dutta P, Attawar S. Clinico-radiological-pathological profile and outcomes of Lung transplantation in post covid-19 phenotype: A single centre experience. Transplant Proc 2022; 54:1494-1503. [PMID: 35654635 PMCID: PMC8995303 DOI: 10.1016/j.transproceed.2022.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/07/2022] [Indexed: 01/08/2023]
Abstract
Background Lung transplantation (LTx) has come as hope for select patients with post-COVID acute respiratory distress syndrome (ARDS). It has a different phenotype with unique challenges. We aimed to bring out our experience with and outcomes of LTx for post-COVID ARDS. Methods This study is retrospective case series from a single center in India. All the patients with post-COVID end stage lung disease (ESLD) who underwent bilateral LTx between 1st May 2020 and 30th August 2021 were included. LTx was performed following no improvement with optimal medical management with adequate time provided for recovery. Information relating to demographics, comorbidities, pretransplant status, perioperative parameters, gross and histopathological findings of explanted lungs, posttransplant morbidity, and mortality were analyzed. Results This study included 23 patients. The median age of the patients in this study was 42 years and 20 participants were men (87%). The mean duration of intensive care unit stay was 15.83 ± 6.61 days. Mortality was observed among 8 participants (34.78%). Mean survival time was 34.54 weeks. Among the 8 patients who expired, the cause of death was sepsis for 6 patients (75.0%), neurologic cerebrovascular accident for 1 patient (12.5%), and cytomegalovirus for 1 patient (12.5%). All the deaths were reported in primary graft dysfunction grade 2 & 3 category. No rejections were observed on first and third month surveillance biopsies. Conclusions LTx is the definitive option for survival in select patients with severe post–COVID-19–associated ESLD. This study brings out various challenges involved in such phenotypes and also observations in postoperative recovery.
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31
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Urlik M, Stącel T, Latos M, Pasek P, Pióro A, Zawadzki F, Gmerek M, Księżopolska P, Przybyłowski P, Ochman M. Lung transplantation as a treatment for patients with end-stage respiratory failure due to Coronavirus disease of 2019 (COVID-19). Transplant Proc 2022; 54:908-912. [PMID: 35725595 PMCID: PMC8995202 DOI: 10.1016/j.transproceed.2022.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022]
Abstract
Background COVID-19 may lead to development of irreversible acute respiratory distress syndrome. Some patients sustain severe respiratory failure after infection subsides. They may require lung transplant as a last resort treatment. The aim of the study is to assess the effect and feasibility of lung transplant as a treatment for patients with severe irreversible respiratory failure due to COVID-19. Methods This retrospective study pertains to analysis of 119 patients in critical condition who were referred to Lung Transplant Ward (Zabrze, Poland). between July 2020 and June 2021 after developing respiratory failure requiring extracorporeal membrane oxygenation, invasive ventilation, or both, as well as a few patients on high-flow oxygen therapy. Inclusion criteria for referral were confirmed lack of viral disease and exhaustion of other therapeutic options. Results Of the referred patients, 21.84% were disqualified from such treatment owing to existing contraindications. Among the suitable patients, 75.8% died without transplant. Among all patients who were qualified for lung transplant, only 9 patients became double lung transplant recipients. Intraoperative mortality for this procedure was 33%. Four patients were discharged after the procedure and are currently self-reliant with full respiratory capacity. Conclusions Patients with severe irreversible respiratory failure after COVID-19 present significantly high mortality without lung transplant. This procedure may present satisfactory results but must be performed in a timely fashion owing to critical condition and scarcity of lung donors, only aggravated around the time of peak infection waves.
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Royo-Villanova Reparaz M, Dominguez-Gil B, Moreno Docón A, Cánovas López SJ, Pastor Pérez FJ, Ortín Freire AJ. Organ donor with PCR positive for SARS-CoV-2, it has been always no? Med Intensiva 2022; 46:225-226. [PMID: 35221237 PMCID: PMC8847091 DOI: 10.1016/j.medine.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/21/2021] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - A Moreno Docón
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | | | - F J Pastor Pérez
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - A J Ortín Freire
- Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
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33
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Bermudez CA, Crespo MM. The Case for Prolonged ECMO for COVID-19 ARDS as a Bridge to Recovery or Lung Transplantation. Transplantation 2022; 106:e198-e199. [PMID: 35135969 PMCID: PMC8942598 DOI: 10.1097/tp.0000000000004063] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Christian A Bermudez
- Division of Cardiovascular Surgery, University of Pennsylvania Health System, Philadelphia, PA
| | - Maria M Crespo
- Division of Pulmonary, Allergy, and Critical Care, University of Pennsylvania Health System, Philadelphia, PA
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Sellarès-Nadal J, Esperalba J, Márquez-Algaba E, Los-Arcos I, Antón A, Nuvials X, Castells L, Len O. Positive Polymerase Chain Reaction for SARS-CoV-2 in a Candidate Does Not Always Preclude Liver Transplantation: Case Report and Literature Review. EXP CLIN TRANSPLANT 2022; 20:321-324. [PMID: 35352636 DOI: 10.6002/ect.2021.0387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We report a case of a liver transplant performed in a patient with a history of SARS-CoV-2 infection who presented with a positive polymerase chain reaction test for SARS-CoV-2 on the day of transplant. The transplant procedure was performed without complications, and the patient did not develop symptoms after the initiation of immunosuppression. We also reviewed the literature for similar cases. The emergence of SARS-CoV-2 has forced the medical community to continuously adapt protocols to the current situation. Prudence is needed in immuno- compromised patients, and clinical experience is being built day by day. Thus, a positive polymerase chain reaction test for SARS-CoV-2 in a recipient should not always prevent a liver transplant.
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Affiliation(s)
- Júlia Sellarès-Nadal
- From the Infectious Diseases Department, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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35
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Kute V, Meshram HS, Fleetwood VA, Chauhan S, Lentine KL. Solid Organ Transplantation in SARS-CoV-2 Recovered Transplant Candidates: a Comprehensive Review of Recent Literature. CURRENT TRANSPLANTATION REPORTS 2022; 9:95-107. [PMID: 35284204 PMCID: PMC8904162 DOI: 10.1007/s40472-022-00362-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW As the coronavirus disease 2019 (COVID-19) pandemic continues to surge, determining the safety and timing of proceeding with solid organ transplantation (SOT) in transplant candidates who have recovered from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and who are otherwise transplant eligible is an important concern. We reviewed the current status of protocols and the outcomes of SOT in SARS-CoV-2 recovered patients. RECENT FINDINGS We identified 44 published reports up through 7 September 2021, comprising 183 SOT [kidney = 115; lung = 27; liver = 36; heart = 3; simultaneous pancreas-kidney (SPK) = 1, small bowel = 1] transplants in SARS-CoV-2 recovered patients. The majority of these were living donor transplants. A positive SARS-CoV-2 antibody test, although not obligatory in most reports, was a useful tool to strengthen the decision to proceed with transplant. Two consecutive real-time polymerase chain test (RT-PCR) negative tests was one of the main prerequisites for transplant in many reports. However, some reports suggest that life-saving transplantation can proceed in select circumstances without waiting for a negative RT-PCR. In general, the standard immunosuppression regimen was not changed. SUMMARY In select cases, SOT in COVID-19 recovered patients appears successful in short-term follow-up. Emergency SOT can be performed with active SARS-CoV-2 infection in some cases. In general, continuing standard immunosuppression regimen may be reasonable, except in cases of inadvertent transplantation with active SARS-CoV-2. Available reports are predominantly in kidney transplant recipients, and more data for other organ transplants are needed.
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Affiliation(s)
- Vivek Kute
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Hari Shankar Meshram
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Vidya A. Fleetwood
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO USA
| | - Sanshriti Chauhan
- Department of Nephrology and Transplantation, Institute of Kidney Diseases and Research Center and Dr. H L Trivedi Institute of Transplantation Sciences (IKDRC-ITS), Ahmedabad, India
| | - Krista L. Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, Saint Louis, MO USA
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36
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Koch A, Pizanis N, Bessa V, Herbstreit F, Gulbins E, Aigner C, Kamler M. Lung Transplantation for Adult Respiratory Distress Syndrome after SARS-CoV-2 Infection. Thorac Cardiovasc Surg Rep 2022; 11:e23-e26. [PMID: 35251890 PMCID: PMC8890928 DOI: 10.1055/s-0042-1742714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 11/10/2021] [Indexed: 11/02/2022] Open
Abstract
Background The majority of patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection present mild symptoms. However, some patients develop severe acute respiratory distress syndrome (ARDS) and subsequent irreversible lung damage despite extracorporeal membrane oxygenation, leaving lung transplantation the ultimate therapeutically option. Case Description Here, we report a case of lung transplantation in a 31-year-old male recipient suffering from post-coronavirus disease 2019 respiratory failure with irreversible ARDS after prolonged extracorporeal membrane oxygenation therapy. Conclusion Patient selection criteria are elucidated. One relevant mechanism for susceptibility to SARS-CoV-2 in the respiratory system, the acid sphingomyelinase/ceramide system might be altered during infection with SARS-CoV-2.
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Affiliation(s)
- Achim Koch
- Department of Thoracic and Cardiovascular Surgery, University of Duisburg-Essen Faculty of Medicine, Essen, Northrhine-Westfalia, Germany
| | - Nikolaus Pizanis
- Department of Thoracic and Cardiovascular Surgery, University of Duisburg-Essen Faculty of Medicine, Essen, Northrhine-Westfalia, Germany
| | - Vasiliki Bessa
- Department of Pulmonology, University of Duisburg-Essen Faculty of Medicine, Essen, Northrhine-Westfalia, Germany
| | - Frank Herbstreit
- Department of Anesthesiology, University of Duisburg-Essen Faculty of Medicine, Essen, Northrhine-Westfalia, Germany
| | - Erich Gulbins
- Institute for Molecular Biology, University of Duisburg-Essen Faculty of Medicine, Essen, Northrhine-Westfalia, Germany
| | - Clemens Aigner
- Department of Thoracic Surgery, Universitat Duisburg-Essen Medizinische Fakultat, Essen, Germany
| | - Markus Kamler
- Thorax und Kardiovaskuläre Chirurgie, Universitätsklinikum Essen, Essen, Germany.,Herzchirurgie, Herzzentrum Essen, Essen, Germany
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Hagbom M, Carmona-Vicente N, Sharma S, Olsson H, Jämtberg M, Nilsdotter-Augustinsson Å, Sjöwall J, Nordgren J. Evaluation of SARS-CoV-2 rapid antigen diagnostic tests for saliva samples. Heliyon 2022; 8:e08998. [PMID: 35233472 PMCID: PMC8860750 DOI: 10.1016/j.heliyon.2022.e08998] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 11/18/2021] [Accepted: 02/18/2022] [Indexed: 12/23/2022] Open
Abstract
Using saliva samples would facilitate sample collection, diagnostic feasibility, and mass screening of SARS-CoV-2. We tested two rapid antigen (RAD) immunochromatographic tests designed for detection of SARS-CoV-2 in saliva: Rapid Response™ COVID-19 Antigen Rapid Test Cassette for oral fluids and DIAGNOS™ COVID-19 Antigen Saliva Test. Evaluation of detection limit was performed with purified SARS-CoV-2 nucleocapsid protein and live SARS-CoV-2 virus. Sensitivity and specificity were further evaluated with reverse transcription quantitative PCR (RT-qPCR) positive and negative saliva samples from hospitalized individuals with COVID-19 (n = 39) and healthcare workers (n = 20). DIAGNOS showed higher sensitivity than Rapid Response for both nucleocapsid protein and live virus. The limit of detection of the saliva test from DIAGNOS was further comparable with the Abbott Panbio™ COVID-19 Ag Rapid Test designed for nasopharyngeal samples. DIAGNOS and Rapid Response detected nine (50.0%) and seven (38.9%), respectively, of the 18 RT-qPCR positive saliva samples. All RT-qPCR negative saliva (n = 41) were negative with both tests. Only one of the RT-qPCR positive saliva samples contained infectious virus as determined by cell culture and was also positive using the saliva RADs. The results show that the DIAGNOS may be an important and easy-to-use saliva RAD complement to detect SARS-CoV-2 positive individuals, but validation with a larger sample set is warranted.
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Affiliation(s)
- Marie Hagbom
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85, Linköping, Sweden
| | - Noelia Carmona-Vicente
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85, Linköping, Sweden
| | - Sumit Sharma
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85, Linköping, Sweden
| | - Henrik Olsson
- Noviral Sweden AB, Västmannagatan 3, 111 24, Stockholm, Sweden
| | - Mikael Jämtberg
- Noviral Sweden AB, Västmannagatan 3, 111 24, Stockholm, Sweden
| | - Åsa Nilsdotter-Augustinsson
- Infectious Diseases/Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johanna Sjöwall
- Infectious Diseases/Division of Inflammation and Infection, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Johan Nordgren
- Division of Molecular Medicine and Virology, Department of Biomedical and Clinical Sciences, Linköping University, 581 85, Linköping, Sweden
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Franco-Palacios DJ, Allenspach L, Stagner L, Pinto J, Olexsey K, Sherbin E, Dillon W, Sternberg D, Bryce K, Simanovski J, Apostolou D, Tanaka D, Nemeh H, Wang Z, Alangaden G. A center experience with lung transplantation for COVID-19 ARDS. Respir Med Case Rep 2022; 36:101597. [PMID: 35127437 PMCID: PMC8806016 DOI: 10.1016/j.rmcr.2022.101597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/19/2022] [Accepted: 01/24/2022] [Indexed: 12/14/2022] Open
Abstract
COVID-19 can cause irreversible lung damage from acute respiratory distress syndrome (ARDS), chronic respiratory failure associated with post COVID-19 de novo fibrosis or worsening of an underlying fibrotic lung disease. Pregnant women are at increased risk for invasive mechanical ventilation, extracorporeal membrane oxygenation, and death. The Centers for Disease Control and Prevention reported more than 22,000 hospitalizations and 161 deaths for COVID-19 in pregnant women. Between August 2020 and September 2021, five patients underwent bilateral lung transplant (LT) for COVID-19 ARDS at the Henry Ford Hospital in Detroit, Michigan. De-identified demographics data, clinical characteristics, perioperative challenges, explanted lung pathology, and post-transplant outcomes are described. In post-hospitalization follow-up (median survival 273 days), we see improving endurance and excellent lung function. One patient did not survive to hospital discharge and succumbed to complications 5 months after LT. We report the first cases of bilateral LT in two postpartum women.
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Affiliation(s)
| | - Lisa Allenspach
- Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Lisa Stagner
- Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Julio Pinto
- Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Kaitlin Olexsey
- Pulmonary and Critical Care Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Eve Sherbin
- Infectious Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - William Dillon
- Infectious Diseases, Henry Ford Hospital, Detroit, MI, USA
| | - Daniel Sternberg
- Physical Therapy and Rehabilitation, Henry Ford Hospital, Detroit, MI, USA
| | - Kelly Bryce
- Transplant Institute, Henry Ford Hospital, Detroit, MI, USA
| | | | | | - Diazo Tanaka
- Thoracic Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Hassan Nemeh
- Thoracic Surgery, Henry Ford Hospital, Detroit, MI, USA
| | - Zhiqiang Wang
- Pathology Department, Henry Ford Hospital, Detroit, MI, USA
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Rabi AS, Muniappan A. Commentary: Crossing the Rubicon—pre-emptive recipient bilateral pneumonectomy and delayed lung transplantation. JTCVS Tech 2022; 13:288-289. [PMID: 35224517 PMCID: PMC8861834 DOI: 10.1016/j.xjtc.2022.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 01/31/2022] [Accepted: 02/15/2022] [Indexed: 12/09/2022] Open
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40
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Shigemura N, Cordova F, Hayanga AJ, Criner G, Toyoda Y. Lung transplantation and coronavirus disease 2019 (COVID-19): a roadmap for the enduring pandemic. J Thorac Dis 2022; 13:6755-6759. [PMID: 35070359 PMCID: PMC8743399 DOI: 10.21037/jtd-21-1667] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/05/2021] [Indexed: 12/24/2022]
Affiliation(s)
- Norihisa Shigemura
- Division of Cardiovascular Surgery, Department of Surgery, Temple University Health System, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Francis Cordova
- Department of Thoracic Medicine and Surgery, Temple University Health System and Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Awori J Hayanga
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, WV, USA
| | - Gerard Criner
- Department of Thoracic Medicine and Surgery, Temple University Health System and Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Yoshiya Toyoda
- Division of Cardiovascular Surgery, Department of Surgery, Temple University Health System, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
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41
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Long-term Outcome and Bridging Success of Patients Evaluated and Bridged to Lung Transplantation on the ICU. J Heart Lung Transplant 2022; 41:589-598. [DOI: 10.1016/j.healun.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/20/2022] Open
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42
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Ghodsizad A, Grant AA, Mohammed AN, Navas-Blanco J, Ruhparwar A, Mirsaeidi M, Hare JM, DeMarchena E, Loebe M. Bilateral pneumonectomy and lung transplant for COVID-19 induced respiratory failure. JTCVS Tech 2022; 13:282-287. [PMID: 35098171 PMCID: PMC8780122 DOI: 10.1016/j.xjtc.2022.01.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 01/12/2022] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ali Ghodsizad
- Division of Cardiothoracic Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, Fla
- Address for reprints: Ali Ghodsizad, MD, PhD, Division of Cardiothoracic Surgery, University of Miami, Leonard M. Miller School of Medicine, 1801 NW 9th Ave, 6th Floor, Miami, FL 33136.
| | - April A. Grant
- Department of Surgery, Emory University School of Medicine and Grady Hospital, Atlanta, Ga
| | - Asif N. Mohammed
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Leonard M. Miller School of Medicine, Miami, Fla
| | - Jose Navas-Blanco
- Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami, Leonard M. Miller School of Medicine, Miami, Fla
| | - Arjang Ruhparwar
- Department of Thoracic and Cardiovascular Surgery, University Hospital Essen, Essen, Germany
| | - Mehdi Mirsaeidi
- Division of Pulmonary Critical Care, University of Miami, Leonard M. Miller School of Medicine, Miami, Fla
| | - Joshua M. Hare
- Division of Cardiology, University of Miami, Leonard M. Miller School of Medicine, Miami, Fla
| | - Eduardo DeMarchena
- Division of Cardiology, University of Miami, Leonard M. Miller School of Medicine, Miami, Fla
| | - Matthias Loebe
- Division of Cardiothoracic Surgery, Dewitt Daughtry Family Department of Surgery, University of Miami, Leonard M. Miller School of Medicine, Miami, Fla
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43
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Khajotia R. Increasing incidence of lung transplantation in patients with post-COVID-19 pulmonary fibrosis. Pan Afr Med J 2022; 40:169. [PMID: 34970411 PMCID: PMC8683460 DOI: 10.11604/pamj.2021.40.169.31223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/22/2021] [Indexed: 11/11/2022] Open
Abstract
Twenty months into the COVID-19 pandemic, we are still learning about the various long-term consequences of COVID-19 infection. While many patients do recover with minimal long-term consequences, some patients develop irreversible parenchymal and interstitial lung damage leading to diffuse pulmonary fibrosis. Unfortunately, these are some of the consequences of post-SARS-CoV-2 infection which thousands more people around the world will experience and which will outlast the pandemic for a long time to come. It is now being observed at various leading medical centres around the world that lung transplantation may be the only meaningful treatment available to a select group of patients experiencing serious lung damage and non-resolving COVID-19-associated respiratory failure, resulting from the triad of coronavirus infection, a hyper-inflammatory immune response to it and the inability of the human body to repair that injury.
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Affiliation(s)
- Rumi Khajotia
- Department of Internal Medicine, International Medical University, Seremban, Malaysia
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44
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Hsin M, Cypel M. Commentary: Gift of life in the time of COVID-19. J Thorac Cardiovasc Surg 2022; 163:337-338. [PMID: 33419557 PMCID: PMC7695944 DOI: 10.1016/j.jtcvs.2020.11.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 12/05/2022]
Affiliation(s)
- Michael Hsin
- Department of Cardiothoracic Surgery, Queen Mary Hospital, Hong Kong, China.
| | - Marcelo Cypel
- Division of Thoracic Surgery, University of Toronto, Toronto, Ontario, Canada
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45
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Pola dos Reis F, Fernandes LM, Abdalla LG, Campos SV, de Camargo PCLB, dos Santos SL, de Aguiar IT, Pires JP, Costa AN, Carraro RM, Teixeira RHDOB, Pêgo-Fernandes PM. Brazilian initial experience with lung transplantation due to irreversible lung fibrosis post-COVID-19 in a national reference center: a cohort study. SAO PAULO MED J 2021; 140:S1516-31802021005030204. [PMID: 34932782 PMCID: PMC9623839 DOI: 10.1590/1516-3180.2021.0842.r1.13102021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Revised: 10/05/2021] [Accepted: 10/13/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Lung transplantation (LTx) has been discussed as an option for treating irreversible lung fibrosis post-coronavirus disease 2019 (COVID-19), in selected cases. OBJECTIVES To report on the initial experience and management of end-stage lung disease due to COVID-19 at a national center reference in Brazil. DESIGN AND SETTING Cohort study conducted at a national reference center for lung transplantation. METHODS Medical charts were reviewed regarding patients' demographics and pre-COVID-19 characteristics, post-LTx due to COVID-19. RESULTS Between March 2020 and September 2021, there were 33 cases of LTx. During this period, we evaluated 11 cases of severe COVID-19-related acute respiratory distress syndrome (ARDS) that were potentially candidates for LTx. Among these, LTx was only indicated for three patients (9.1%). All of these patients were on venovenous extracorporeal membrane oxygenation (ECMO), and the procedure that they underwent was central venoarterial ECMO. All three patients were still alive after the first 30 postoperative days. However, patient #1 and patient #2 subsequently died due to fungal sepsis on the 47th and 52nd postoperative days, respectively. Patient #3 was discharged on the 30th postoperative day. CONCLUSIONS LTx is feasible among these complex patients. Survival over the first 30 days was 100%, and this favors surgical feasibility. Nonetheless, these were critically ill patients.
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Affiliation(s)
- Flavio Pola dos Reis
- MD. Attending Surgeon, Thoracic Surgery Program, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Lucas Matos Fernandes
- MD, PhD. Attending Surgeon, Thoracic Surgery Program, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Luis Gustavo Abdalla
- MD. Attending Surgeon, Thoracic Surgery Program, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Silvia Vidal Campos
- MD. Attending Physician, Division of Pulmonology, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Priscila Cilene Leon Bueno de Camargo
- MD, PhD. Attending Physician, Division of Pulmonology, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Samuel Lucas dos Santos
- MD. Lung Transplant Resident, Thoracic Surgery Program, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Ivana Teixeira de Aguiar
- MD. Lung Transplant Fellow, Thoracic Surgery Program, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Juliana Patricia Pires
- MD. Lung Transplant Fellow. Division of Pulmonology, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Andre Nathan Costa
- MD, PhD. Attending Physician, Division of Pulmonology, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Rafael Medeiros Carraro
- MD. Attending Physician, Division of Pulmonology, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Ricardo Henrique de Oliveira Braga Teixeira
- MD, PhD. Attending Physician, Division of Pulmonology, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR.
| | - Paulo Manuel Pêgo-Fernandes
- MD, PhD. Full Professor, Thoracic Surgery Program, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, BR; Director, Scientific Department, Associação Paulista de Medicina, São Paulo (SP), Brazil.
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46
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Messika J, Roux A, Dauriat G, Pavec JL. Lung Transplantation in the COVID-19 Era: A Multi-Faceted Challenge. Respir Med Res 2021; 81:100866. [PMID: 35533474 PMCID: PMC9074448 DOI: 10.1016/j.resmer.2021.100866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/08/2021] [Indexed: 12/23/2022]
Affiliation(s)
- Jonathan Messika
- APHP.Nord-Université de Paris, Hôpital Bichat, Pulmonology B and Lung Transplantation Department, F-75018, Paris, France; Université de Paris, INSERM PHERE UMRS 1152, F-75018 Paris, France; Paris Transplant Group, Paris, France.
| | - Antoine Roux
- Paris Transplant Group, Paris, France; Pulmonology, Adult Cystic Fibrosis Centre, and Lung Transplantation Department, Foch Hospital, Suresnes, France; Versailles-Saint-Quentin-en-Yvelines University, Versailles, France
| | - Gaëlle Dauriat
- Paris-Saclay University, School of Medicine, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies Unit, Marie Lannelongue Hospital, Paris Saint-Joseph Hospital Group, Le Plessis-Robinson, France; Marie Lannelongue Hospital, Paris Saint-Joseph Hospital Group, Department of transplantation and thoracic and vascular surgery, Pulmonary Hypertension National Referral Centre, Le Plessis Robinson, France
| | - Jérôme Le Pavec
- Paris-Saclay University, School of Medicine, Le Kremlin-Bicêtre, France; INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies Unit, Marie Lannelongue Hospital, Paris Saint-Joseph Hospital Group, Le Plessis-Robinson, France; Marie Lannelongue Hospital, Paris Saint-Joseph Hospital Group, Department of transplantation and thoracic and vascular surgery, Pulmonary Hypertension National Referral Centre, Le Plessis Robinson, France
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47
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Yeung JC, Cypel M, Chaparro C, Keshavjee S. La transplantation pulmonaire dans le contexte de la COVID-19 aiguë : l’expérience du Programme de transplantation pulmonaire de Toronto. CMAJ 2021; 193:E1786-E1790. [PMID: 34810168 PMCID: PMC8608452 DOI: 10.1503/cmaj.211143-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jonathan C Yeung
- Programme de transplantation pulmonaire de Toronto, Hôpital général de Toronto, Toronto, Ont
| | - Marcelo Cypel
- Programme de transplantation pulmonaire de Toronto, Hôpital général de Toronto, Toronto, Ont.
| | - Cecilia Chaparro
- Programme de transplantation pulmonaire de Toronto, Hôpital général de Toronto, Toronto, Ont
| | - Shaf Keshavjee
- Programme de transplantation pulmonaire de Toronto, Hôpital général de Toronto, Toronto, Ont
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48
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Whitsett M, Ortiz V, Weinberg EM. CON: Liver Transplantation in the Times of COVID-19: Patients with COVID-19 Infection Should not Undergo Liver Transplantation. Clin Liver Dis (Hoboken) 2021; 18:233-236. [PMID: 34840724 PMCID: PMC8605695 DOI: 10.1002/cld.1136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/21/2021] [Accepted: 05/05/2021] [Indexed: 02/04/2023] Open
Affiliation(s)
- Maureen Whitsett
- Department of Gastroenterology and HepatologyHospital of the University of PennsylvaniaPhiladelphiaPAUSA,Department of MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
| | - Vivian Ortiz
- Department of Gastroenterology and HepatologyHospital of the University of PennsylvaniaPhiladelphiaPAUSA,Department of MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
| | - Ethan M. Weinberg
- Department of Gastroenterology and HepatologyHospital of the University of PennsylvaniaPhiladelphiaPAUSA,Department of MedicineHospital of the University of PennsylvaniaPhiladelphiaPAUSA
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49
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Hall DJ, Schulte JJ, Lewis EE, Bommareddi SR, Rohrer CT, Sultan S, Maloney JD, DeCamp MM, McCarthy DP. Successful Lung Transplantation for Severe Post COVID-19 Pulmonary Fibrosis. Ann Thorac Surg 2021; 114:e17-e19. [PMID: 34748736 PMCID: PMC8570389 DOI: 10.1016/j.athoracsur.2021.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 10/17/2021] [Indexed: 11/24/2022]
Abstract
Lung transplantation has been well described for patients with coronavirus disease 2019 (COVID-19) in the acute setting, but less so for the resulting pulmonary sequelae. This report describes a case of lung transplantation for post–COVID-19 pulmonary fibrosis. A 52-year-old woman contracted COVID-19 in July 2020 and mounted a partial recovery, but she went on to have declining function over the ensuing 3 months, with development of fibrocystic lung changes. She underwent bilateral lung transplantation and recovered rapidly, was discharged home on postoperative day 14, and has done well in follow-up. This case report demonstrates that lung transplantation is an acceptable therapy for post–COVID-19 pulmonary fibrosis.
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Affiliation(s)
- David J Hall
- Division of Cardiothoracic Surgery, Department of Surgery; Department of Pathology and Laboratory Medicine
| | - Jefree J Schulte
- ; Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine
| | - Erik E Lewis
- Division of Cardiothoracic Surgery, Department of Surgery; Department of Pathology and Laboratory Medicine
| | - Swaroop R Bommareddi
- Division of Cardiothoracic Surgery, Department of Surgery; Department of Pathology and Laboratory Medicine
| | - Charles T Rohrer
- ; Division of Allergy, Pulmonary, and Critical Care Medicine, Department of Medicine
| | - Samir Sultan
- ;University of Wisconsin School of Medicine and Public Health, Madison, WI , USA
| | - James D Maloney
- Division of Cardiothoracic Surgery, Department of Surgery; Department of Pathology and Laboratory Medicine
| | - Malcolm M DeCamp
- Division of Cardiothoracic Surgery, Department of Surgery; Department of Pathology and Laboratory Medicine
| | - Daniel P McCarthy
- Division of Cardiothoracic Surgery, Department of Surgery; Department of Pathology and Laboratory Medicine.
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50
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Gogia P, Attawar S, Singh V, Bhatnagar T, Sharma S, Batra K, Khare S. Lung transplantation for post-COVID-19 pulmonary fibrosis. Respirol Case Rep 2021; 9:e0862. [PMID: 34707876 PMCID: PMC8524671 DOI: 10.1002/rcr2.862] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/21/2021] [Accepted: 09/26/2021] [Indexed: 01/08/2023] Open
Abstract
COVID-19 has affected over a billion people around the world, with over 2 million losing their lives (Worldometer). About 10% of patients infected with COVID-19 develop a serious illness, including respiratory failure, that require advanced life-supporting measures. Mortality among this subgroup exceeds 60%. We present a case of an otherwise healthy 34-year-old male who developed end-stage pulmonary fibrosis following COVID-19 infection. He achieved haemodynamic stability with mechanical ventilation and extracorporeal membrane oxygenation (ECMO) but did not show any sign of weaning off ECMO; however, he successfully underwent bilateral lung transplantation.
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Affiliation(s)
- Pratibha Gogia
- Department of Respiratory MedicineVenkateshwar Hospital, DwarkaNew DelhiIndia
| | - Sandeep Attawar
- Heart and Lung Transplant InstituteKrishna Institute of Medical Sciences Secunderabad Hospital, Ringgold Standard Institution, Ministers RoadSecunderabadTelanganaIndia
| | - Vivek Singh
- Heart and Lung Transplant InstituteKrishna Institute of Medical Sciences Secunderabad Hospital, Ringgold Standard Institution, Ministers RoadSecunderabadTelanganaIndia
| | - Tarun Bhatnagar
- Department of Respiratory MedicineVenkateshwar Hospital, DwarkaNew DelhiIndia
| | - Sanjay Sharma
- Department of Respiratory MedicineVenkateshwar Hospital, DwarkaNew DelhiIndia
| | - Khushboo Batra
- Department of Respiratory MedicineVenkateshwar Hospital, DwarkaNew DelhiIndia
| | - Swapnil Khare
- Department of Respiratory MedicineVenkateshwar Hospital, DwarkaNew DelhiIndia
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