Background The long-term pulmonary sequelae of coronavirus disease 2019 (COVID-19) is not well known. Purpose To characterize patterns and rates of improvement of chest CT abnormalities one year after COVID-19 pneumonia. Materials and Methods This was a secondary analysis of a prospective, multicenter observational cohort study conducted from April 29 to August 12, 2020 to assess pulmonary abnormalities on chest CT at approximately 2, 3, 6 months, and 1 year after onset of COVID-19 symptoms. Pulmonary findings were graded for each lung lobe using a qualitative CT severity score (CTSS), range 0 (normal) to 25 (all lobes involved). The association of demographic and clinical factors with CT abnormalities after 1 year was assessed with logistic regression. The rate of change of the CTSS at follow-up CT was investigated by Friedmann test. Results Out of 142 enrolled participants, 91 participants had a 1-year follow-up CT and were included in the analysis [mean age, 59 years ± 13 [standard deviation]; 35 women (38%)]. In 49/91 (54%) participants, CT abnormalities were observed: 31/91 (34%) participants showed subtle subpleural reticulation, ground-glass opacities or both and 18/91 (20%) participants revealed extensive ground-glass opacities, reticulations, bronchial dilation and/or microcystic changes. In multivariable analysis, age > 60 years (OR 5.8 [95% CI: 1.7 - 24]; p = .009) critical COVID-19 severity (OR 29 [95% CI: 4.8 - 280]; p < .001) and male gender (OR 8.9 [95% CI: 2.6 - 36]; p < .001) were associated with persistent CT abnormalities at 1 year. Reduction of CTSS was observed in participants in subsequent follow-up CTs (p < .001) and during the study period 49% (69/142) of participants had complete resolution of CT abnormalities. 31/49 (63%) participants with CT abnormalities did not show further improvement after 6 months. Conclusion Long-term CT abnormalities were common 1 year after COVID-19 pneumonia. The study is registered at ClinicalTrials.gov number (registration number NCT04416100). See also the editorial by Leung .

The majority of organs used for liver transplantation come from brain-dead donors (DBD). In order to overcome the organ shortage, increasingly donation after circulatory death (DCD) organs are also considered. Since normothermic machine perfusion (NMP) restores metabolic activity and allows for in-depth assessment of organ quality and function prior to transplantation, such organs may benefit from NMP. We herein compare the bioenergetic performance through a comprehensive evaluation of mitochondria by high-resolution respirometry in tissue biopsies and the inflammatory response in DBD and DCD livers during NMP. While livers were indistinguishable by perfusate biomarker assessment and histology, our findings revealed a greater impairment of mitochondrial function in DCD livers after static cold storage compared to DBD livers. During subsequent NMPs, DCD organs recovered and eventually showed a similar performance as DBD livers. Cytokine expression analysis showed no differences in the early phase of NMP, while towards the end of NMP, significantly elevated levels of IL-1β, IL-5 and IL-6 were found in the perfusate of DCD livers. Based on our results, we find it worthwhile to reconsider more DCD organs for transplantation to further extend the donor pool. Therefore, donor organ quality criteria must be developed, which may include an assessment of bioenergetic function and cytokine quantification.

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