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肺移植受者与新型冠状病毒肺炎:两例报告

Lung Transplant Recipients and COVID-19: Report of Two Cases.

作者信息

Antonacci Filippo, Petroncini Matteo, Salvaterra Elena, Bertoglio Pietro, Daddi Niccolò, Lai Giulia, Brandolini Jury, Solli Piergiorgio, Dolci Giampiero

机构信息

Thoracic Surgery, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.

Interventional Pulmonology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, 40138 Bologna, Italy.

出版信息

J Clin Med. 2023 Jun 26;12(13):4287. doi: 10.3390/jcm12134287.

Abstract

Although the WHO has declared the end of the pandemic emergency, COVID-19 still poses a threat to immunocompromised patients. The COVID-19 pandemic has spread throughout the world over the last two years, causing a significant number of deaths. After three years, SARS-CoV-2 has lost its initial lethality but has shown a significantly worse prognosis for immunocompromised patients, especially those who have undergone lung transplantation, compared with the general population. This paper presents two compelling case studies that highlight the complex challenges of COVID-19 infection in lung transplant recipients. The first case involves a patient who received a bilateral lung transplant for pulmonary artery hypertension in 2009, followed by a kidney transplant in 2022. Surprisingly, despite an initially favorable clinical course after contracting COVID-19, the patient deteriorated rapidly and died within a few days due to extensive lung involvement. This case highlights the unpredictable nature of COVID-19 and its potentially devastating impact on lung transplant recipients. The second case involves a patient who underwent bilateral lung transplantation five years earlier for chronic obstructive pulmonary disease (COPD). This individual also contracted COVID-19 and had pre-existing complications, including chronic lung allograft rejection (CLAD) and diffuse bronchial stenosis. Following viral infection, the patient's clinical condition deteriorated rapidly, with worsening bronchial stenosis. This case highlights the ability of COVID-19 to exacerbate pre-existing pulmonary complications in transplant recipients. These cases highlight the urgent need for increased vigilance and tailored management strategies when dealing with COVID-19 in lung transplant recipients. The unpredictable and detrimental course of the disease observed in these patients highlights the importance of implementing stringent preventive measures, such as vaccination and strict adherence to infection control protocols, in this vulnerable population. Further research is essential to gain a full understanding of the unique dynamics of COVID-19 in lung transplant recipients and to develop targeted interventions to improve their outcomes.

摘要

尽管世界卫生组织已宣布大流行紧急状态结束,但新冠病毒仍对免疫功能低下的患者构成威胁。在过去两年里,新冠疫情已蔓延至全球,导致大量死亡。三年后,严重急性呼吸综合征冠状病毒2(SARS-CoV-2)已失去其最初的致死性,但与普通人群相比,免疫功能低下的患者,尤其是接受过肺移植的患者,其预后明显更差。本文介绍了两个引人关注的案例研究,突出了肺移植受者感染新冠病毒的复杂挑战。第一个案例涉及一名患者,他于2009年因肺动脉高压接受了双侧肺移植,2022年又接受了肾移植。令人惊讶的是,尽管感染新冠病毒后最初临床病程良好,但该患者病情迅速恶化,数天内因肺部广泛受累而死亡。这个案例突出了新冠病毒的不可预测性及其对肺移植受者潜在的毁灭性影响。第二个案例涉及一名患者,他五年前因慢性阻塞性肺疾病(COPD)接受了双侧肺移植。该患者也感染了新冠病毒,且存在包括慢性肺移植排斥反应(CLAD)和弥漫性支气管狭窄在内的既往并发症。病毒感染后,患者的临床状况迅速恶化,支气管狭窄加重。这个案例突出了新冠病毒加剧移植受者既往肺部并发症的能力。这些案例突出了在应对肺移植受者的新冠病毒感染时,迫切需要提高警惕并制定针对性的管理策略。在这些患者中观察到的疾病不可预测且有害的病程突出了在这一脆弱人群中实施严格预防措施的重要性,如接种疫苗和严格遵守感染控制方案。进一步的研究对于全面了解新冠病毒在肺移植受者中的独特动态以及制定有针对性的干预措施以改善他们的预后至关重要。

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