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利用 COVID-19 康复供体的同种异体肺成功进行肺移植:亚基因组 RNA 指导器官利用的潜在作用。

Successful lung transplantation using an allograft from a COVID-19-recovered donor: a potential role for subgenomic RNA to guide organ utilization.

机构信息

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.

出版信息

Am J Transplant. 2023 Jan;23(1):101-107. doi: 10.1016/j.ajt.2022.09.001. Epub 2023 Jan 11.


DOI:10.1016/j.ajt.2022.09.001
PMID:36695611
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9833374/
Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9905/9833374/fd408d2ab89c/gr3_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9905/9833374/9b0879052e47/gr1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9905/9833374/175eda30f62b/gr2_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9905/9833374/fd408d2ab89c/gr3_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9905/9833374/9b0879052e47/gr1_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9905/9833374/175eda30f62b/gr2_lrg.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9905/9833374/fd408d2ab89c/gr3_lrg.jpg

相似文献

[1]
Successful lung transplantation using an allograft from a COVID-19-recovered donor: a potential role for subgenomic RNA to guide organ utilization.

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[5]
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[6]
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[7]
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[8]
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[9]
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[10]
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引用本文的文献

[1]
Acceptance of Organs from Deceased Donors With Resolved or Active SARS-CoV-2 Infection: A Survey From the Council of Europe.

Transpl Int. 2024-11-21

[2]
Non-Standard Risk Donors and Risk of Donor-Derived Infections: From Evaluation to Therapeutic Management.

Transpl Int. 2024

[3]
COVID-19 seropositive donors yield comparable post-lung transplant outcomes.

J Thorac Dis. 2024-7-30

[4]
Donor-derived infections in solid organ transplant recipients.

Curr Opin Organ Transplant. 2023-10-1

[5]
Analytical validation of quantitative SARS-CoV-2 subgenomic and viral load laboratory developed tests conducted on the Panther Fusion® (Hologic) with preliminary application to clinical samples.

PLoS One. 2023

[6]
Viable SARS-CoV-2 Omicron sub-variants isolated from autopsy tissues.

Front Microbiol. 2023-5-22

本文引用的文献

[1]
SARS-CoV-2 infection and persistence in the human body and brain at autopsy.

Nature. 2022-12

[2]
Detectable Duration of Viable SARS-CoV-2, Total and Subgenomic SARS-CoV-2 RNA in Noncritically Ill COVID-19 Patients: a Prospective Cohort Study.

Microbiol Spectr. 2022-6-29

[3]
RNA SARS-CoV-2 Persistence in the Lung of Severe COVID-19 Patients: A Case Series of Autopsies.

Front Microbiol. 2022-1-31

[4]
Successful kidney transplantation from a deceased donor with severe COVID-19 respiratory illness with undetectable SARS-CoV-2 in donor kidney and aorta.

Am J Transplant. 2022-5

[5]
Use of Organs from SARS-CoV-2 Infected Donors: Is It Safe? A Contemporary Review.

Curr Transplant Rep. 2021

[6]
Viral Culture Confirmed SARS-CoV-2 Subgenomic RNA Value as a Good Surrogate Marker of Infectivity.

J Clin Microbiol. 2022-1-19

[7]
Liver transplantation from active COVID-19 donors: A lifesaving opportunity worth grasping?

Am J Transplant. 2021-12

[8]
Diagnostic usefulness of subgenomic RNA detection of viable SARS-CoV-2 in patients with COVID-19.

Clin Microbiol Infect. 2022-1

[9]
Lung donation following SARS-CoV-2 infection.

Am J Transplant. 2021-12

[10]
Successful Lung Transplantation From a Donor Who Had Recovered From Severe Acute Respiratory Syndrome Coronavirus 2 Pneumonia.

Ann Thorac Surg. 2022-5

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