Brazilian initial experience with lung transplantation due to irreversible lung fibrosis post-COVID-19 in a national reference center: a cohort study

Abstract

BACKGROUND: Lung transplantation (LTx) has been discussed as an option for treating irreversible lung fibrosis post-coronavirus disease 2019 (COVID-19), in selected cases. OBJECTIVES: To report on the initial experience and management of end-stage lung disease due to COVID-19 at a national center reference in Brazil. DESIGN AND SETTING: Cohort study conducted at a national reference center for lung transplantation. METHODS: Medical charts were reviewed regarding patients' demographics and pre-COVID-19 characteristics, post-LTx due to COVID-19. RESULTS: Between March 2020 and September 2021, there were 33 cases of LTx. During this period, we evaluated 11 cases of severe COVID-19-related acute respiratory distress syndrome (ARDS) that were potentially candidates for LTx. Among these, LTx was only indicated for three patients (9.1%). All of these patients were on venovenous extracorporeal membrane oxygenation (ECMO), and the procedure that they underwent was central venoarterial ECMO. All three patients were still alive after the first 30 postoperative days. However, patient #1 and patient #2 subsequently died due to fungal sepsis on the 47 th and 52 nd postoperative days, respectively. Patient #3 was discharged on the 30 th postoperative day. CONCLUSIONS: LTx is feasible among these complex patients. Survival over the first 30 days was 100%, and this favors surgical feasibility. Nonetheless, these were critically ill patients.

Conocimientos sobre el mantenimiento del donante pulmonar

“…Se realizaron 21 trasplantes pulmonares, originando una tasa de trasplante pulmonar de 0,46 por millón de habitantes, lo que representa una reducción del 40% en relación con el año anterior 6 . Por otro lado, vale mencionar que, a diferencia de otros países de la región 7 , en la Argentina todavía no se realizaron trasplantes de pulmón por fibrosis pulmonar irreversible pos-COVID-19.…”

Lung Transplantation for COVID-19–related Lung Disease: Clinical Experience and Call for a Global Registry

“…The severe parenchymal destruction, extensive pleural involvement‚ and reactive lymphadenopathy often result in very difficult mobilization of the native lungs, resulting in longer surgery and cold ischemia times, increased need for intraoperative blood products, and a higher incidence of primary graft dysfunction. 16 Secondary colonization or infection with bacterial or fungal organisms is a common complication of prolonged critical illness, mechanical ventilation, and pleural instrumentation. It is largely unclear how this affects posttransplant outcomes, although some cases of postoperative morbidity and mortality related to bacterial 17 and fungal sepsis 16 have been reported.…”

“… 16 Secondary colonization or infection with bacterial or fungal organisms is a common complication of prolonged critical illness, mechanical ventilation, and pleural instrumentation. It is largely unclear how this affects posttransplant outcomes, although some cases of postoperative morbidity and mortality related to bacterial 17 and fungal sepsis 16 have been reported.…”

“…Most of the early available case reports only document short-term posttransplant outcomes on single patients or case series. 7 , 8 , 11 , 16 - 18 Very recently, analyses of larger patient cohorts over a longer time span have been published: A retrospective analysis of the United Network of Organ Sharing database reported outcomes on 214 patients who received lung transplantation for COVID-19–related respiratory failure in the United States 2 with a median follow-up of 1.9 mo. Patients were relatively young (mean age 52 y) and predominantly male (79.2%)‚ and included a high percentage of patients of Hispanic origin (36.6%), consistent with reports that have identified a higher risk of COVID-19–related respiratory failure in this group.…”

New challenges for lung transplantation in the era of COVID-19

“…In this manner, contamination within the operative field was avoided, as described in an article published in this edition of the São Paulo Medical Journal. 10 Another complicating factor was that the patients very commonly presented pneumothorax and firm pleuro-pulmonary adhesions, and even drains were present. We chose to start the surgery on the side most affected by the disease, as is usually done, using the side with lower perfusion.…”