Wuxi Lung Transplant Center, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, China.
Department of Thoracic Surgery, Shenzhen Third People's Hospital, Shenzhen, Guangdong 518100, China.
Chin Med J (Engl). 2020 Jun 20;133(12):1390-1396. doi: 10.1097/CM9.0000000000000839.
Critical patients with the coronavirus disease 2019 (COVID-19), even those whose nucleic acid test results had turned negative and those receiving maximal medical support, have been noted to progress to irreversible fatal respiratory failure. Lung transplantation (LT) as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients.
From February 10 to March 10, 2020, three male patients were urgently assessed and listed for transplantation. After conducting a full ethical review and after obtaining assent from the family of the patients, we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores.
Two of the three recipients survived post-LT and started participating in a rehabilitation program. Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved. The pathological results of the explanted lungs were concordant with the critical clinical manifestation, and provided insight towards better understanding of the disease. Government health affair systems, virology detection tools, and modern communication technology all play key roles towards the survival of the patients and their rehabilitation.
LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis. If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT, LT provided the final option for these patients to avoid certain death, with proper protection of transplant surgeons and medical staffs. By ensuring instant seamless care for both patients and medical teams, the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.
患有 2019 年冠状病毒病（COVID-19）的危重症患者，甚至那些核酸检测结果已转为阴性且接受最大程度医疗支持的患者，已被观察到进展为无法逆转的致命性呼吸衰竭。肺移植（LT）作为急性呼吸窘迫综合征相关终末期肺纤维化的唯一治疗方法，被认为是这些患者的最终抢救治疗方法。
2020 年 2 月 10 日至 3 月 10 日，有 3 名男性患者被紧急评估并列入移植名单。在进行全面的伦理审查并获得患者家属同意后，我们对 3 名 COVID-19 患者进行了 LT 手术，这些患者的病程超过 1 个月，序贯器官衰竭评估评分极高。
3 名受者中有 2 名在 LT 后存活下来，并开始参加康复计划。总结了 LT 团队合作和围手术期后勤工作的要点，并不断改进。移植肺的病理结果与危急的临床表现一致，为更好地了解疾病提供了依据。政府卫生事务系统、病毒学检测工具和现代通信技术都对患者的生存和康复起着关键作用。
LT 可用于因 COVID-19 相关肺纤维化而导致呼吸衰竭的终末期患者。如果确认病毒学状态已由阳性转为阴性，且器官功能无 LT 禁忌证，LT 可为这些患者提供避免死亡的最后选择，同时适当保护移植外科医生和医务人员。通过确保患者和医疗团队即时无缝的护理，可达到降低 COVID-19 死亡率和挽救患者生命的目标。
