Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Virginia, Charlottesville, VA.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Virginia, Charlottesville, VA.
Transplantation. 2021 Jun 1;105(6):1381-1387. doi: 10.1097/TP.0000000000003706.
The coronavirus disease 2019 (COVID-19) pandemic has resulted in >72 million cases and 1.6 million deaths. End-stage lung disease from COVID-19 is a new and growing entity that may benefit from lung transplant; however, there are limited data on the patient selection, perioperative management, and expected outcomes of transplantation for this indication.
A systematic review of the literature was performed with searches of MEDLINE and Web of Science databases as well as the gray literature. All manuscripts, editorials, commentaries, and gray literature reports of lung transplantation for COVID-related respiratory failure were included. A case from the University of Virginia is described and included in the review.
A total of 27 studies were included: 11 manuscripts, 5 commentaries, and 11 gray literature reports. The total number of transplantations for COVID-related lung disease was 21. The mean age was 55±12 years, 16 (76%) were male individuals, and the acuity was high, with 85% on extracorporeal membrane oxygenation preoperatively. There was a 95% early survival rate, with 1 additional late death. There is growing histopathologic evidence for permanent structural damage with no replicating virus at the time of transplantation.
Bilateral lung transplantation is an effective treatment option with reasonable short-term outcomes for patients with end-stage lung failure secondary to COVID-19. However, specific considerations in this new population require a multidisciplinary approach. As we move into the second wave of the COVID-19 global pandemic, lung transplantation will likely have a growing role in management of these complex patients.
2019 年冠状病毒病（COVID-19）大流行导致超过 7200 万例病例和 160 万人死亡。COVID-19 导致的终末期肺病是一种新的、不断增长的实体，可能受益于肺移植；然而，对于这种适应症，关于患者选择、围手术期管理和移植的预期结果的数据有限。
对 MEDLINE 和 Web of Science 数据库以及灰色文献进行了系统的文献检索，检索了肺移植治疗 COVID 相关呼吸衰竭的文献。描述了弗吉尼亚大学的一个病例，并将其纳入了综述。
共纳入 27 项研究：11 篇手稿、5 篇评论和 11 篇灰色文献报告。COVID 相关肺病的移植总数为 21 例。平均年龄为 55±12 岁，16 例（76%）为男性，发病急，术前 85%在体外膜肺氧合治疗。早期存活率为 95%，另有 1 例晚期死亡。移植时无复制病毒的永久性结构损伤的组织病理学证据越来越多。
双侧肺移植是一种有效的治疗选择，对于 COVID-19 导致的终末期肺衰竭患者具有合理的短期结果。然而，在这一新人群中，需要采用多学科方法来考虑特定问题。随着 COVID-19 全球大流行进入第二波，肺移植在管理这些复杂患者方面可能会发挥越来越大的作用。
