Lung transplantation for COVID-19-associated acute respiratory distress syndrome in a PCR-positive patient

Lang, Christian; Jaksch, Péter; Hoda, Mir Alireza; Láng, György; Staudinger, Thomas; Tschernko, Edda; Zapletal, Bernhard; Geleff, Silvana; Prosch, Helmut; Gawish, Riem; Knapp, Sylvia; Robak, Oliver; Thalhammer, Florian; Indra, Alexander; Koestenberger, Markus; Straßl, Robert; Klikovits, Thomas; Ali, Kamran; Fischer, Gottfried; Klepetko, Walter; Höetzenecker, Konrad; Schellongowski, Peter

doi:10.1016/s2213-2600(20)30361-1

Cited by 111 publications

(137 citation statements)

References 16 publications

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“…In the first such case reported, the explanted lungs of a 44-year-old woman who underwent bilateral lung transplantation on day 58 showed large zones of necrosis, DAD, and widespread thromboemboli. 33 Interestingly, while cultures were negative at the time of transplantation, polymerase chain reaction (PCR) testing remained positive. Two earlier preliminary reports from China documented the feasibility of lung transplantation for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR-negative patients.…”

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confidence: 99%

Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation

Aesif¹,

Bribriesco²,

Yadav

et al. 2020

American Journal of Clinical Pathology

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Objectives Current knowledge of the pulmonary pathology of coronavirus disease 2019 (COVID-19) is based largely on postmortem studies. In most, the interval between disease onset and death is relatively short (<1 month). Information regarding lung pathology in patients who survive for longer periods is scant. We describe the pathology in three patients with severe COVID-19 who underwent antemortem examination of lung tissue at least 8 weeks after initial diagnosis. Methods We conducted a retrospective case series. Results The first patient developed acute respiratory failure and was started on extracorporeal membrane oxygenation (ECMO) on day 21, with subsequent hemothorax. Debridement (day 38) showed extensive lung infarction with diffuse alveolar damage and Candida overgrowth. The second patient developed acute respiratory failure requiring mechanical ventilation that did not improve despite ECMO. Surgical lung biopsy on day 74 showed diffuse interstitial fibrosis with focal microscopic honeycomb change. The third patient also required ECMO and underwent bilateral lung transplantation on day 126. The explanted lungs showed diffuse interstitial fibrosis with focal microscopic honeycomb change. Conclusions This series provides histologic confirmation that complications of COVID-19 after 8 weeks to 4 months of severe disease include lung infarction and diffuse interstitial fibrosis.

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Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation

Aesif¹,

Bribriesco²,

Yadav

et al. 2020

American Journal of Clinical Pathology

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“…Of late, it is concluded that ground-glass opacity, with or without consolidation, was most commonly noted among COVID-19 patients. The COVID-19 Reporting and Data System (CO-RADS) grants a level of conjecture for pulmonary involvement of COVID-19, formed on the countenance seen at unenhanced chest CT [1,2].…”

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confidence: 99%

“…In a case report by Lang et al on LT for COVID-19linked ARDS [1], a 44-year-old woman tested positive for SARS-CoV-2 through nasopharyngeal swab real-time polymerase chain reaction (RT-PCR). Her respiratory condition worsened, requiring femoro-femoral veno-venous extracorporeal membrane oxygenation (ECMO).…”

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confidence: 99%

“…When not controlled medically, after 48 days, she was considered a possible candidate for LT. On pulmonary CT, there was evidence of complete consolidation of the lungs coupled with large necrotic areas and air inclusions, substantial infarctions of the peripheral parts of the lung parenchyma and thrombosis of small and medium-sized pulmonary arteries. Finally, a sequential bilateral LT was performed [1]. Surgeons from Chicago have also given a new set of lungs to a young woman with severe lung damage from COVID-19 [3].…”

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confidence: 99%

“…The patient should have had significant bilateral irreparable lung damage, and the patient should have single-organ involvement, preferably less than 65 years of age, with intact neurological status and sufficient muscle strength to participate in the extensive post-surgery rehabilitation process. LT should be performed by a team with sufficient experience in managing ECMO and high-risk LT [1].…”

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The starfish story and lung transplantation for COVID-19

Sharma

Subramaniam²

2020

Indian J Thorac Cardiovasc Surg

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Outcomes Following Lung Transplant for COVID-19–Related Complications in the US

et al. 2023

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ImportanceThe COVID-19 pandemic led to the use of lung transplant as a lifesaving therapy for patients with irreversible lung injury. Limited information is currently available regarding the outcomes associated with this treatment modality.ObjectiveTo describe the outcomes following lung transplant for COVID-19–related acute respiratory distress syndrome or pulmonary fibrosis.Design, Setting, and ParticipantsIn this cohort study, lung transplant recipient and donor characteristics and outcomes following lung transplant for COVID-19–related acute respiratory distress syndrome or pulmonary fibrosis were extracted from the US United Network for Organ Sharing database from March 2020 to August 2022 with a median (IQR) follow-up period of 186 (64-359) days in the acute respiratory distress syndrome group and 181 (40-350) days in the pulmonary fibrosis group. Overall survival was calculated using the Kaplan-Meier method. Cox proportional regression models were used to examine the association of certain variables with overall survival.ExposuresLung transplant following COVID-19–related acute respiratory distress syndrome or pulmonary fibrosis.Main Outcomes and MeasuresOverall survival and graft failure rates.ResultsAmong 385 included patients undergoing lung transplant, 195 had COVID-19–related acute respiratory distress syndrome (142 male [72.8%]; median [IQR] age, 46 [38-54] years; median [IQR] allocation score, 88.3 [80.5-91.1]) and 190 had COVID-19–related pulmonary fibrosis (150 male [78.9%]; median [IQR] age, 54 [45-62]; median [IQR] allocation score, 78.5 [47.7-88.3]). There were 16 instances of acute rejection (8.7%) in the acute respiratory distress syndrome group and 15 (8.6%) in the pulmonary fibrosis group. The 1-, 6-, and 12- month overall survival rates were 0.99 (95% CI, 0.96-0.99), 0.95 (95% CI, 0.91-0.98), and 0.88 (95% CI, 0.80-0.94) for the acute respiratory distress syndrome cohort and 0.96 (95% CI, 0.92-0.98), 0.92 (95% CI, 0.86-0.96), and 0.84 (95% CI, 0.74-0.90) for the pulmonary fibrosis cohort. Freedom from graft failure rates were 0.98 (95% CI, 0.96-0.99), 0.95 (95% CI, 0.90-0.97), and 0.88 (95% CI, 0.79-0.93) in the 1-, 6-, and 12-month follow-up periods in the acute respiratory distress cohort and 0.96 (95% CI, 0.92-0.98), 0.93 (95% CI, 0.87-0.96), and 0.85 (95% CI, 0.74-0.91) in the pulmonary fibrosis cohort, respectively. Receiving a graft from a donor with a heavy and prolonged history of smoking was associated with worse overall survival in the acute respiratory distress syndrome cohort, whereas the characteristics associated with worse overall survival in the pulmonary fibrosis cohort included female recipient, male donor, and high recipient body mass index.Conclusions and RelevanceIn this study, outcomes following lung transplant were similar in patients with irreversible respiratory failure due to COVID-19 and those with other pretransplant etiologies.

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Lung transplantation for COVID-19-associated acute respiratory distress syndrome in a PCR-positive patient

Cited by 111 publications

References 16 publications

Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation

Pulmonary Pathology of COVID-19 Following 8 Weeks to 4 Months of Severe Disease: A Report of Three Cases, Including One With Bilateral Lung Transplantation

The starfish story and lung transplantation for COVID-19

Outcomes Following Lung Transplant for COVID-19–Related Complications in the US

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