Javaid Hana, Nigo Masayuki, Zhao Bihong, Trujillo Daniel Ocazionez, Hasbun Rodrigo, Ostrosky-Zeichner Luis, Patel Manish, Jyothula Soma
Division of Infectious Diseases, Department of Internal Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Division of Pathology and Laboratory Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Open Forum Infect Dis. 2022 Aug 17;9(9):ofac425. doi: 10.1093/ofid/ofac425. eCollection 2022 Sep.
A significant proportion of patients with severe and persistent coronavirus disease 2019 (COVID-19) require continuous ventilatory support and occasional extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS). Lung transplantation is a treatment option for patients who develop severe ARDS.
Our lung transplant database was retrospectively reviewed for patients who underwent lung transplantation for COVID-19 pulmonary disease at Memorial Hermann Hospital, Texas Medical Center, Houston, Texas, from January 2020 to March 2022. We evaluated outcomes of patients who were followed in our clinic at least 6 months post-transplant. Pretransplant patient characteristics, COVID-19-related treatment, histopathology results, and postdischarge course were evaluated.
Among a total of 13 lung transplant recipients, 6 consecutive patients were identified who had a minimum of 6 months of follow-up post-lung transplantation. The average age of patients was 55 years, with a male predominance. The median time to transplantation was 111 days. All 6 patients had significant postinfectious complications due to COVID-19 before transplant. Histopathological findings from explanted lungs showed a predominance of fibrotic change. There were no reported cases of rejection or graft dysfunction. 5 patients had minimal to no post-transplant infectious complications. One patient died 218 days post-transplant from infectious complications.
Five out of six lung transplant recipients at our institution have demonstrated excellent long-term outcomes after index hospitalization, for a mean follow-up of 13 months post-lung transplantation. Lung transplantation for lung fibrosis due to COVID-19 is an acceptable salvage treatment option. Larger studies are warranted to confirm these findings.
相当一部分患有严重持续性2019冠状病毒病（COVID-19）的患者因急性呼吸窘迫综合征（ARDS）需要持续通气支持，偶尔还需要体外膜肺氧合（ECMO）。肺移植是发生严重ARDS患者的一种治疗选择。
我们回顾性分析了2020年1月至2022年3月在德克萨斯州休斯顿市德克萨斯医疗中心纪念赫尔曼医院因COVID-19肺部疾病接受肺移植的患者的肺移植数据库。我们评估了移植后在我们诊所随访至少6个月的患者的结局。评估了移植前患者特征、COVID-19相关治疗、组织病理学结果和出院后病程。
在总共13例肺移植受者中，确定了6例连续患者，他们在肺移植后至少随访了6个月。患者的平均年龄为55岁，以男性为主。移植的中位时间为111天。所有6例患者在移植前均因COVID-19出现严重的感染后并发症。切除肺的组织病理学结果显示纤维化改变占主导。没有排斥反应或移植物功能障碍的报告病例。5例患者移植后感染并发症极少或无。1例患者在移植后218天因感染并发症死亡。
我们机构的6例肺移植受者中有5例在首次住院后显示出良好的长期结局，肺移植后平均随访13个月。因COVID-19导致的肺纤维化进行肺移植是一种可接受的挽救治疗选择。需要更大规模的研究来证实这些发现。
