Palleschi Alessandro, Crotti Stefania, Scandroglio Anna Mara, Lissoni Alfredo, Fominskiy Evgeny, Rosso Lorenzo, Tosi Davide, Musso Valeria, Blasi Francesco, Gori Andrea, Nosotti Mario
Department of Pathophysiology and Transplantation, Università degli Studi di Milano, 20122 Milan, Italy.
Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda-Ospedale Maggiore Policlinico, 20122 Milan, Italy.
J Clin Med. 2022 Aug 15;11(16):4754. doi: 10.3390/jcm11164754.
During the first outbreak of COVID-19 in Italy, based on the only few cases reported from a Chinese centre at the time, we performed lung transplantation in two patients with irreversible acute respiratory distress syndrome (ARDS) after COVID-19 at our centre. After two years, we report the outcomes of these cases and some considerations. The first patient, an 18-year-old male, is in excellent conditions twenty-four months after surgery. The second patient was a 48-year-old man; his airways were colonized by carbapenemase-producing klebsiella pneumoniae at the time of lung transplantation, and he had previously suffered from delirium and hallucinations in the intensive care unit. His postoperative clinical course was complicated by dysexecutive behaviour and then septic shock; he died 62 days after surgery. The recently reported experience of different transplantation centres has led to the inclusion of irreversible acute respiratory distress syndrome (ARDS) after COVID-19 among the indications for lung transplantation in carefully selected patients. Our results confirm the feasibility and the good long-term outcomes of lung transplantation for COVID-19-associated ARDS. Nonetheless, our experience corroborates the need for careful recipient selection: special attention must be paid to the single-organ dysfunction principle, the evaluation of any neuro-psychiatric disorder, and MDR germs colonization, before listing.
在意大利首次爆发新冠疫情期间，基于当时中国一家中心报告的为数不多的病例，我们在本中心为两名新冠病毒感染后出现不可逆急性呼吸窘迫综合征（ARDS）的患者进行了肺移植手术。两年后，我们报告了这些病例的结果及一些思考。首例患者为一名18岁男性，术后24个月情况良好。第二例患者是一名48岁男性；在肺移植时其气道被产碳青霉烯酶肺炎克雷伯菌定植，且他此前在重症监护病房出现过谵妄和幻觉。他术后的临床过程因执行功能障碍行为继而发生感染性休克而复杂化；他在术后62天死亡。最近不同移植中心报告的经验已导致将新冠病毒感染后不可逆急性呼吸窘迫综合征（ARDS）纳入精心挑选患者的肺移植适应证中。我们的结果证实了针对新冠病毒相关ARDS进行肺移植的可行性及良好的长期疗效。尽管如此，我们的经验确证了仔细选择受者的必要性：在列入名单之前，必须特别关注单器官功能障碍原则、对任何神经精神障碍的评估以及多重耐药菌定植情况。
