Division of Infectious Diseases, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Emerging Pathogens Section, Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA; Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, USA.
Am J Transplant. 2023 Jan;23(1):101-107. doi: 10.1016/j.ajt.2022.09.001. Epub 2023 Jan 11.
Although the risk of SARS-CoV-2 transmission through lung transplantation from acutely infected donors is high, the risks of virus transmission and long-term lung allograft outcomes are not as well described when using pulmonary organs from COVID-19-recovered donors. We describe successful lung transplantation for a COVID-19-related lung injury using lungs from a COVID-19-recovered donor who was retrospectively found to have detectable genomic SARS-CoV-2 RNA in the lung tissue by multiple highly sensitive assays. However, SARS-CoV-2 subgenomic RNA (sgRNA), a marker of viral replication, was not detectable in the donor respiratory tissues. One year after lung transplantation, the recipient has a good functional status, walking 1 mile several times per week without the need for supplemental oxygen and without any evidence of donor-derived SARS-CoV-2 transmission. Our findings highlight the limitations of current clinical laboratory diagnostic assays in detecting the persistence of SARS-CoV-2 RNA in the lung tissue. The persistence of SARS-CoV-2 RNA in the donor tissue did not appear to represent active viral replication via sgRNA testing and, most importantly, did not negatively impact the allograft outcome in the first year after lung transplantation. sgRNA is easily performed and may be a useful assay for assessing viral infectivity in organs from donors with a recent infection.
虽然从急性感染供体肺移植中传播 SARS-CoV-2 的风险很高,但使用 COVID-19 康复供体的肺进行移植时,病毒传播和长期肺移植物结果的风险描述得并不充分。我们描述了一例成功的 COVID-19 相关肺损伤肺移植,供体是一名 COVID-19 康复者,通过多个高度敏感的检测发现其肺部组织中存在可检测的 SARS-CoV-2 基因组 RNA。然而,在供体呼吸道组织中未检测到 SARS-CoV-2 亚基因组 RNA(sgRNA),这是病毒复制的标志物。肺移植 1 年后,受者的功能状态良好,每周步行数英里,无需补充氧气,也没有任何供体来源的 SARS-CoV-2 传播的证据。我们的研究结果强调了当前临床实验室诊断检测方法在检测肺部组织中 SARS-CoV-2 RNA 持续存在方面的局限性。sgRNA 检测显示,供体组织中 SARS-CoV-2 RNA 的持续存在似乎不代表病毒的复制,最重要的是,这并没有对肺移植后 1 年内的移植物结果产生负面影响。sgRNA 易于操作,可能是评估近期感染供体器官中病毒传染性的有用检测方法。
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