Division of Thoracic Surgery, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Division of Pulmonary and Critical Care Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Am J Transplant. 2021 Dec;21(12):4073-4078. doi: 10.1111/ajt.16777. Epub 2021 Aug 9.
There have been over 177 million cases of COVID-19 worldwide, many of whom could be organ donors. Concomitantly, there is an anticipated increase in the need for donor lungs due to expanding indications. Given that the respiratory tract is most commonly affected by COVID-19, there is an urgent need to develop donor assessment criteria while demonstrating safety and "efficacy" of lung donation following COVID-19 infection. Accordingly, we report an intentional transplant using lungs from a donor with recent, microbiologically confirmed, COVID-19 infection into a recipient suffering from COVID-19 induced ARDS and pulmonary fibrosis. In addition to the standard clinical assays, both donor and recipient lungs were analyzed using RNAscope, which confirmed that tissues were negative for SARS-CoV-2. Immunohistochemistry demonstrated colocalized KRT17+ basaloid-like epithelium and COL1A1+ fibroblasts, a marker suggestive of lung fibrosis in COVID-19 associated lung disease, in the explanted recipient lungs but absent in the donor lungs. We demonstrate that following a thorough assessment, lung donation following resolved COVID-19 infection is safe and feasible.
全球已有超过 1.77 亿例 COVID-19 病例,其中许多人可能是器官捐献者。同时,由于适应症的扩大,预计对供体肺的需求将会增加。鉴于 COVID-19 主要影响呼吸道,因此迫切需要制定供体评估标准,并在 COVID-19 感染后证明肺捐献的安全性和“疗效”。因此,我们报告了一例使用最近经微生物学确认患有 COVID-19 的供体的肺进行移植,受者患有 COVID-19 诱导的急性呼吸窘迫综合征和肺纤维化。除了标准的临床检测外,还使用 RNAscope 对供体和受体的肺进行了分析,结果证实组织中没有 SARS-CoV-2。免疫组织化学显示,在移植受体的肺中存在 COL1A1+成纤维细胞和 KRT17+基底样上皮细胞的共定位,这是 COVID-19 相关肺部疾病中肺纤维化的标志物,但在供体肺中不存在。我们证明,在经过彻底评估后,COVID-19 感染后进行肺捐献是安全可行的。
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