Kurihara Chitaru, Kaiho Taisuke, Toyoda Takahide, Thomae Benjamin, O'Boye Anne, Lysne Jeffrey, Bharat Ankit
Division of Thoracic Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
J Thorac Dis. 2024 Jul 30;16(7):4487-4494. doi: 10.21037/jtd-24-496. Epub 2024 Jul 23.
Recent reports have suggested that coronavirus disease 2019 (COVID-19) infection can cause pneumonitis even in the absence of clinical symptoms and COVID-19 associated pulmonary inflammation can persist resulting in long-term fibrosis. This single-center study utilized standardized immunological testing to determine whether lungs from COVID-19 seropositive donors, indicative of past COVID-19 infection, can be safely used for clinical transplantation.
The study included 90 consecutive lung transplant procedures incorporating donor serological testing for past COVID-19 infection. Donors were negative for active COVID-19 infection and met institutional criteria to be used for lung transplantation. The outcomes of lung transplant recipients were compared between donors with and without serological evidence of past COVID-19 infection.
No significant difference was found in post-transplant survival rates between recipients of lungs obtained from donors with serological evidence compared to those without. Additionally, there were no significant differences in primary graft dysfunction grade 3 rates or other post-transplant clinical parameters, such as operative time, ischemic time, extracorporeal membrane oxygenation use, intensive care unit stay, and hospital stay.
Our findings suggest that lungs from COVID-19 seropositive donors, but not active COVID-19 infection are safe and feasible for transplantation, yielding comparable post-transplant outcomes to donors who are negative COVID-19 antibodies. This study supports the utilization of lungs from donors with historic COVID-19 infection as long as they meet current transplant criteria, potentially addressing the concerns related to the use of such organs.
最近的报告表明，2019冠状病毒病（COVID-19）感染即使在没有临床症状的情况下也可导致肺炎，且COVID-19相关的肺部炎症可能持续存在，导致长期纤维化。这项单中心研究利用标准化免疫检测来确定来自COVID-19血清反应阳性供体（表明过去曾感染COVID-19）的肺是否可安全用于临床移植。
该研究纳入了90例连续的肺移植手术，对供体进行了过去COVID-19感染的血清学检测。供体的活动性COVID-19感染呈阴性，符合用于肺移植的机构标准。比较了有和没有过去COVID-19感染血清学证据的供体的肺移植受者的结局。
与没有血清学证据的供体相比，从有血清学证据的供体获得肺的受者的移植后生存率没有显著差异。此外，在3级原发性移植物功能障碍发生率或其他移植后临床参数方面，如手术时间、缺血时间、体外膜肺氧合使用情况、重症监护病房停留时间和住院时间，也没有显著差异。
我们的研究结果表明，来自COVID-19血清反应阳性供体的肺，但不是活动性COVID-19感染的肺，用于移植是安全可行的，移植后结局与COVID-19抗体阴性的供体相当。这项研究支持利用曾感染COVID-19的供体的肺，只要它们符合当前的移植标准，这可能解决与此类器官使用相关的担忧。
