COVID-19 in a Lung Transplant Patient: Rapid Progressive Chronic Lung Allograft Dysfunction

Türkkan, Sinan; Beyoğlu, Muhammet Ali; Şahin, Furkan; Yazicioğlu, Alkın; Özay, Hülya Yiğit; Tekçe, Yasemin Tezer; Demırağ, Funda; Yekeler, Erdal

doi:10.6002/ect.2020.0563

Cited by 5 publications

(6 citation statements)

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“…Another work reported serial lung biopsies in a lung transplant recipient during and following hospitalization for severe SARS‐CoV‐2 infection and found diffuse alveolar damage, a lymphocytic and eosinophilic immune infiltrate, and fibrin clusters in the alveoli at the time of diagnosis 14 . These features were still present at follow‐up bronchoscopy 2 weeks later.…”

Section: Discussionmentioning

confidence: 99%

“…7-10 These works have found characteristic findings in the lungs of patients with severe COVID-19 such as diffuse alveolar damage, microthrombi, massive inflammatory infiltration, and increased megakaryocytes.Additional works examining biopsy specimens in symptomatic patients have found similar histopathologic alternations, including acute lung injury, interstitial pneumonia, type II pneumocyte hyperplasia, and septal thickening [11][12][13]. Another work reported serial lung biopsies in a lung transplant recipient during and following hospitalization for severe SARS-CoV-2 infection and found diffuse alveolar damage, a lymphocytic and eosinophilic immune infiltrate, and fibrin clusters in the alveoli at the time of diagnosis 14. These features were still present at follow-up bronchoscopy 2 weeks later.…”

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confidence: 87%

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Evolution of pathological findings in surveillance biopsies of lung transplant recipients infected with SARS‐CoV‐2

Wein

Liu

Lin

2022

Transplant Infectious Dis

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Background Previous reports of coronavirus disease 2019 (COVID‐19) following lung transplantation generally described a grim prognosis, but these were anecdotal case series of symptomatic patients. A systematic study of the outcomes and pathology of SARS‐CoV‐2 infection in a large cohort of lung transplant patients is lacking. Methods To determine the histopathologic evolution of COVID‐19 in lung transplant recipients, we identified all patients who underwent surveillance transbronchial biopsies at our institution, tested positive for SARS‐CoV‐2, and had multiple pathology specimens available for evaluation. Histology was reviewed and immunofluorescence for SARS‐CoV‐2 nucleocapsid protein was performed. Results Ten patients met inclusion criteria. Half (5/10) had incidental diagnosis on routine respiratory pathogen testing at the time of transbronchial biopsy. Six patients were hospitalized, with three requiring intensive care unit (ICU) admission. One patient died. Two specimens showed new onset International Society for Heart and Lung Transplantation (ISHLT) Grade A2 rejection at or following diagnosis. One patient developed bronchiolitis obliterans 111 days following diagnosis and 1 year post transplant. Two patients had organizing pneumonia at diagnosis and three patients showed evolving lung injury following diagnosis. The SARS‐CoV‐2 nucleocapsid protein was detected in a subset of samples at diagnosis and up to 111 days following diagnosis. Conclusions Overall, the pathology of SARS‐CoV‐2 infection in lung transplant patients is varied, ranging from no pathologic alterations to organizing pneumonia and lung injury. The pathology findings did not necessarily correlate with clinical acuity, as one patient admitted to the ICU had normal pathology. These findings may be generalizable to non‐transplant patients and require more follow‐up regarding long‐term outcomes.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 87%

Evolution of pathological findings in surveillance biopsies of lung transplant recipients infected with SARS‐CoV‐2

Wein

Liu

Lin

2022

Transplant Infectious Dis

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“…Indeed, there are isolated reports of LT patients with COVID‐19 experiencing accelerated progression to CLAD after recovering from acute infection. 13 , 14 …”

Section: Introductionmentioning

confidence: 99%

“…These considerations raise the concerns regarding the long‐term implications of COVID‐19 among LT patients and its impact on the allograft. Indeed, there are isolated reports of LT patients with COVID‐19 experiencing accelerated progression to CLAD after recovering from acute infection 13,14 …”

Section: Introductionmentioning

confidence: 99%

“…Indeed, there are isolated reports of LT patients with COVID-19 experiencing accelerated progression to CLAD after recovering from acute infection. 13,14 The current work reports the outcomes after COVID-19 among LT patients who survive acute illness, focusing on post-infection spirometry. We sought to determine the frequency of significant loss of lung functions assessed via spirometry among a cohort of COVID-19 survivors.…”

Section: Introductionmentioning

confidence: 99%

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Post‐infection pulmonary sequelae after COVID‐19 among patients with lung transplantation

Mahan

Lill

Halverson

et al. 2021

Transplant Infectious Dis

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Background There is limited data on outcomes among lung transplant (LT) patients who survive Coronavirus disease 2019 (COVID‐19). Methods Any single or bilateral LT patients who tested positive for SARS‐CoV‐2 between March 1, 2020, to February 15, 2021 ( n = 54) and survived the acute illness were included (final n = 44). Each patient completed at least 3 months of follow‐up (median: 4.5; range 3–12 months) after their index hospitalization for COVID‐19. The primary endpoint was a significant loss of lung functions (defined as > 10% decline in forced vital capacity (FVC) or forced expiratory volume in 1 s (FEV 1 ) on two spirometries, at least 3 weeks apart compared to the pre‐infection baseline). Results A majority of the COVID‐19 survivors had persistent parenchymal opacities ( n = 29, 65.9%) on post‐infection CT chest. Patients had significantly impaired functional status, with the majority reporting residual disabilities (Karnofsky performance scale score of 70% or worse; n = 32, 72.7%). A significant loss of lung function was observed among 18 patients (40.9%). Three patients met the criteria for new chronic lung allograft dysfunction (CLAD) following COVID‐19 (5.6%), with all three demonstrating restrictive allograft syndrome phenotype. An absolute lymphocyte count < 0.6 × 10 3 /dl and ferritin > 150 ng/ml at the time of hospital discharge was independently associated with significant lung function loss. Conclusions A significant proportion of COVID‐19 survivors suffer persistent allograft injury. Low absolute lymphocyte counts (ALC) and elevated ferritin levels at the conclusion of the hospital course may provide useful prognostic information and form the basis of a customized strategy for ongoing monitoring and management of allograft dysfunction. Tweet Twitter handle: @AmitBangaMD Lung transplant patients who survive COVID‐19 suffer significant morbidity with persistent pulmonary opacities, loss of lung functions, and functional deficits. Residual elevation of the inflammatory markers is predictive.

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Vaccine Breakthrough Severe COVID-19 in a Lung Recipient

Beyoğlu

Türkkan

Başaran

et al. 2022

Transplantation Proceedings

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COVID-19 in a Lung Transplant Patient: Rapid Progressive Chronic Lung Allograft Dysfunction

Cited by 5 publications

References 0 publications

Evolution of pathological findings in surveillance biopsies of lung transplant recipients infected with SARS‐CoV‐2

Evolution of pathological findings in surveillance biopsies of lung transplant recipients infected with SARS‐CoV‐2

Post‐infection pulmonary sequelae after COVID‐19 among patients with lung transplantation

Vaccine Breakthrough Severe COVID-19 in a Lung Recipient

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