Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Department of Pulmonary Diseases, University Medical Center, Ljubljana, Slovenia.
J Heart Lung Transplant. 2022 Oct;41(10):1501-1510. doi: 10.1016/j.healun.2022.06.020. Epub 2022 Jul 2.
Lung transplantation (LTx) can be considered for selected patients suffering from COVID-19 acute respiratory distress syndrome (ARDS). Secondary sclerosing cholangitis in critically ill (SSC-CIP) patients has been described as a late complication in COVID-19 ARDS survivors, however, rates of SSC-CIP after LTx and factors predicting this detrimental sequela are unknown.
This retrospective analysis included all LTx performed for post-COVID ARDS at 8 European LTx centers between May 2020 and January 2022. Clinical risk factors for SSC-CIP were analyzed over time. Prediction of SSC-CIP was assessed by ROC-analysis.
A total of 40 patients were included in the analysis. Fifteen patients (37.5%) developed SSC-CIP. GGT at the time of listing was significantly higher in patients who developed SSC-CIP (median 661 (IQR 324-871) vs 186 (109-346); p = 0.001). Moreover, higher peak values for GGT (585 vs 128.4; p < 0.001) and ALP (325 vs 160.2; p = 0.015) were found in the 'SSC' group during the waiting period. Both, GGT at the time of listing and peak GGT during the waiting time, could predict SSC-CIP with an AUC of 0.797 (95% CI: 0.647-0.947) and 0.851 (95% CI: 0.707-0.995). Survival of 'SSC' patients was severely impaired compared to 'no SSC' patients (1-year: 46.7% vs 90.2%, log-rank p = 0.004).
SSC-CIP is a severe late complication after LTx for COVID-19 ARDS leading to significant morbidity and mortality. GGT appears to be a sensitive parameter able to predict SSC-CIP even at the time of listing.
肺移植（LTx）可用于治疗患有 COVID-19 急性呼吸窘迫综合征（ARDS）的特定患者。在危重病患者中继发的硬化性胆管炎（SSC-CIP）已被描述为 COVID-19 ARDS 幸存者的晚期并发症，然而，LTx 后 SSC-CIP 的发生率以及预测这种不良后果的因素尚不清楚。
本回顾性分析纳入了 2020 年 5 月至 2022 年 1 月在 8 个欧洲 LTx 中心进行的所有用于治疗 COVID-19 后 ARDS 的 LTx。分析了 SSC-CIP 的临床危险因素随时间的变化。通过 ROC 分析评估 SSC-CIP 的预测。
共纳入 40 例患者进行分析。15 例（37.5%）患者发生 SSC-CIP。发生 SSC-CIP 的患者在列入名单时的 GGT 明显较高（中位数 661（IQR 324-871）比 186（109-346）；p=0.001）。此外，在等待期间，'SSC'组中 GGT 的峰值更高（585 比 128.4；p<0.001）和 ALP 更高（325 比 160.2；p=0.015）。列入名单时的 GGT 和等待期间的 GGT 峰值都可以预测 SSC-CIP，AUC 分别为 0.797（95%CI：0.647-0.947）和 0.851（95%CI：0.707-0.995）。与 '无 SSC'患者相比，'SSC'患者的生存率严重受损（1 年：46.7%比 90.2%，对数秩 p=0.004）。
SSC-CIP 是 COVID-19 ARDS 后 LTx 的严重晚期并发症，导致显著的发病率和死亡率。GGT 似乎是一种敏感的参数，即使在列入名单时也能预测 SSC-CIP。
