COVID-19 肺移植患者的临床特征、管理实践和结局。

Clinical characteristics, management practices, and outcomes among lung transplant patients with COVID-19.

机构信息

Divisions of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.

Infectious Disease and Geographic Medicine, University of Texas Southwestern Medical Center, Dallas, Texas.

出版信息

J Heart Lung Transplant. 2021 Sep;40(9):936-947. doi: 10.1016/j.healun.2021.05.003. Epub 2021 May 18.

DOI:10.1016/j.healun.2021.05.003

PMID:34172387

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8130587/

Abstract

BACKGROUND

There are limited data on management strategies and outcomes among lung transplant (LT) patients with Coronavirus disease 2019 (COVID-19). We implemented management protocols based on the best available evidence and consensus among multidisciplinary teams. The current study reports our experience and outcomes using this protocol-based management strategy.

METHODS

We included single or bilateral LT patients who tested positive for SARS-CoV-2 on nasopharyngeal swab between March 1, 2020, to December 15, 2020 (n = 25; median age: 60, range 20-73 years; M: F 17:8). A group of patients with Respiratory Syncytial Virus (RSV) infection during 2016-18 were included to serve as a comparator group (n = 36).

RESULTS

As compared to RSV, patients with COVID-19 were more likely to present with constitutional symptoms, spirometric decline, pulmonary opacities, new or worsening respiratory failure, and need for ventilator support. Patients with SARS-CoV-2 infection were less likely to receive a multimodality treatment strategy, and they experienced worse post-infection lung function loss, functional decline, and three-month survival. A significant proportion of patients with COVID-19 needed readmission for worsening allograft function (36.4%), and chronic kidney disease at initial presentation was associated with this complication. Lower pre-morbid FEV appeared to increase the risk of new or worsening respiratory failure, which was associated with worse outcomes. Overall hospital survival was 88% (n = 22). Follow-up data was available for all discharged patients (median: 43.5 days, range 15-287 days). A majority had persistent radiological opacities (19/22, 86.4%), with nearly half of the patients with available post-COVID-19 spirometry showing > 10% loss in lung function (6/13, median loss: 14.5%, range 10%-31%).

CONCLUSIONS

Despite similar demographic characteristics and predispositions, LT patients with COVID-19 are sicker and experience worse outcomes as compared to RSV. Despite the availability of newer therapeutic agents, COVID-19 continues to be associated with significant morbidity and mortality.

摘要

背景

关于 COVID-19 肺炎肺移植（LT）患者的管理策略和结果的数据有限。我们根据多学科团队的最佳可用证据和共识制定了管理方案。本研究报告了我们使用该基于方案的管理策略的经验和结果。

方法

我们纳入了 2020 年 3 月 1 日至 2020 年 12 月 15 日期间鼻咽拭子检测 SARS-CoV-2 阳性的单肺或双肺 LT 患者（n=25；中位年龄 60 岁，范围 20-73 岁；男：女 17：8）。纳入了一组 2016-18 年期间患有呼吸道合胞病毒（RSV）感染的患者作为对照组（n=36）。

结果

与 RSV 相比，COVID-19 患者更有可能出现全身症状、肺功能下降、肺部阴影、新发或加重呼吸衰竭以及需要呼吸机支持。SARS-CoV-2 感染患者不太可能接受多模式治疗策略，并且感染后肺功能下降、功能下降和三个月生存率更差。相当一部分 COVID-19 患者需要因移植物功能恶化而再次入院（36.4%），初始表现时慢性肾脏病与这种并发症有关。较低的术前 FEV 似乎增加了新发或加重呼吸衰竭的风险，而这与更差的结果相关。总体医院生存率为 88%（n=22）。所有出院患者均有随访数据（中位随访时间：43.5 天，范围 15-287 天）。大多数患者存在持续的影像学阴影（19/22，86.4%），在可获得 COVID-19 后肺功能检查的患者中，近一半患者的肺功能丧失超过 10%（6/13，中位丧失：14.5%，范围 10%-31%）。