Lang Christian, Ritschl Valentin, Augustin Florian, Lang Gyoergy, Moser Bernhard, Taghavi Shahrokh, Murakoezy Gabriella, Lambers Christopher, Flick Holger, Koestenberger Markus, Brooks Roxane, Muhr Tina, Knotzer Johann, Mydza Daniel, Kaufmann Marc, Staudinger Thomas, Zauner Christian, Krenn Claus, Schaden Eva, Bacher Andreas, Rössler Bernhard, Faybik Peter, Tschernko Edda, Anwar Maria, Markstaller Klaus, Hoefer Daniel, Stamm Tanja, Jaksch Peter, Hoetzenecker Konrad
Dept of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria.
Eur Respir J. 2022 Sep 7;60(3). doi: 10.1183/13993003.02404-2021. Print 2022 Sep.
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.
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.
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.
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.
尽管全球范围内因2019冠状病毒病（COVID-19）诱发的急性呼吸窘迫综合征（ARDS）而进行的肺移植（LTx）数量仍然较少，但人们普遍认为这种治疗方法可以挽救一部分肺部损伤不可逆的重症患者。然而，符合肺移植条件的患者的真实比例、总体预后以及肺移植对疫情的影响尚不清楚。
利用奥地利全国范围内2020年1月1日至2021年5月30日期间确诊感染严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）的住院患者登记数据进行回顾性分析。对被转诊至奥地利两个肺移植中心之一的患者进行分析，并分为接受肺移植和被拒绝肺移植的患者。对所有因COVID-19后ARDS接受肺移植的患者进行详细的预后分析，并与因其他适应症接受肺移植的患者进行比较。
2020年1月1日至2021年5月30日期间，奥地利有39485名患者因COVID-19住院。其中2323人需要机械通气，183人接受体外膜肺氧合（ECMO）支持。106例重症COVID-19 ARDS患者被转诊进行肺移植。其中，19例（18%）接受了肺移植。COVID-19 ARDS肺移植受者术后30天死亡率为0%。在中位随访134（47 - 450）天期间，19例患者中有14例存活。
为了筛选出适合肺移植的患者，将接受ECMO治疗的患者早期转诊至肺移植中心至关重要。肺移植提供了良好的中期预后，应纳入COVID-19后ARDS的治疗方案中。
