Lung transplantation for COVID-19-associated ARDS

Lepper, Philipp M.; Langer, Frank; Wilkens, Heinrike; Schäfers, Hans‐Joachim; Bals, Robert

doi:10.1016/s2213-2600(21)00278-2

Cited by 17 publications

(16 citation statements)

References 5 publications

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“…There have been reports of successful lung transplantation (LTx) in patients with SARS-CoV-2-induced end-stage lung disease, but with rather short follow-up and in most of the cases shorter time on ECMO support before transplantation. [1][2][3][4][5] The worldwide experience with this matter is however limited and it is unknown if and when such a treatment should be offered. 6 Given the poor long-term survival outcome in LTx, in combination with donor lung shortage and ethical questioning of graft allocation, all healing potentials need to be excluded before taking the decision to transplant.…”

Section: Introductionmentioning

confidence: 99%

Lung transplant after 6 months on ECMO support for SARS-CoV-2-induced ARDS complicated by severe antibody-mediated rejection

et al. 2021

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There have been a few reports of successful lung transplantation (LTx) in patients with SARS-CoV-2-induced acute respiratory distress syndrome (ARDS); however, all reports were with rather short follow-up. Here we present a 62-year-old man without prior lung diseases. Following SARS-CoV-2-induced ARDS and 6 months of extracorporeal membrane oxygenation, he underwent LTx. 3 months post-transplantation he developed acute hypoxia requiring emergency intubation. Chest imaging showed acute rejection, and de novo DQ8-DSA was discovered. He was treated with a high dose of corticosteroids and plasmapheresis and was extubated 4 days later, yet the de novo DQ8-DSA remained. After sessions of plasmapheresis and rituximab, the levels of de novo DQ8-DSA remained unchanged. Nine months post-transplantation the patient died of respiratory failure. We herein discuss the decision to transplant, the transplantation itself and the postoperative course with severe antibody-mediated rejection. In addition, we evaluated the histological changes of the explanted lungs and compared these with end-stage idiopathic pulmonary fibrosis tissue, where both similarities and differences are seen. With the current case experience, one might consider close monitoring regarding DSA, and gives further support that LTx should only be considered for very carefully selected patients.

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Section: Introductionmentioning

confidence: 99%

Lung transplant after 6 months on ECMO support for SARS-CoV-2-induced ARDS complicated by severe antibody-mediated rejection

et al. 2021

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“…In very experienced high-volume centers some criteria may be disregarded on a case-by-case basis. As mentioned by Lepper et al, the case series of lung transplantation for COVID-19 described by Bharat et al showed that many patients had a complicated intraoperative and postoperative course, including mass transfusions, continued extracorporeal support, re-thoracotomy, primary graft dysfunction, and prolonged postoperative stay in the ICU [54,59]. However, in this case series, patients did not necessarily fulfill all requirements as mentioned by some other authors [54,56].…”

Section: How Should We Treat Covid-19-related End Stage Lung Disease?mentioning

confidence: 71%

“…As mentioned by Lepper et al, the case series of lung transplantation for COVID-19 described by Bharat et al showed that many patients had a complicated intraoperative and postoperative course, including mass transfusions, continued extracorporeal support, re-thoracotomy, primary graft dysfunction, and prolonged postoperative stay in the ICU [54,59]. However, in this case series, patients did not necessarily fulfill all requirements as mentioned by some other authors [54,56]. Defining the ideal recipient in this situation remains difficult, in which increased in-hospital SARS-CoV-2 transmission, and depleting healthcare resourses should also be taken into account.…”

Section: How Should We Treat Covid-19-related End Stage Lung Disease?mentioning

confidence: 98%

“…Since COVID-19 frequently affects multiple organ systems the short-term and long-term outcomes may differ. ECMO is being used increasingly for COVID-19 patients with improved outcomes [53][54][55]. In the case reports and case series, early outcomes have been acceptable for these marginal lung transplant recipient candidates, although Cypel et al warned about publication bias in the context of a new disease [56].…”

Section: How Should We Treat Covid-19-related End Stage Lung Disease?mentioning

confidence: 99%

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COVID-19-Associated Lung Fibrosis: Two Pathways and Two Phenotypes, Lung Transplantation, and Antifibrotics

Hage

Schuurmans

2022

Transplantology

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COVID-19 can be associated with lung fibrosis. Although lung fibrosis after COVID-19 is a relatively rare finding, the mere fact that globally a very large number of patients have had COVID-19 leads to a significant burden of disease. However, patients with COVID-19-associated lung fibrosis have different clinical and radiological features. The aim of this review is to define the different phenotypes of COVID-19-associated lung fibrosis, based on the medical literature. We found that two phenotypes have emerged. One phenotype is COVID-19-related acute respiratory distress syndrome (CARDS); the other phenotype is post-COVID-19 pulmonary fibrosis (PCPF). Both phenotypes have different risk factors, clinical, and radiological features, and differ in their pathophysiological mechanisms and prognoses. A long-term follow-up of patients with pulmonary complications after COVID-19 is warranted, even in patients with only discrete fibrosis. Further studies are needed to determine the optimal treatment because currently the literature is scarce, and evidence is only based on small case series or case reports.

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“…In accordance with the conclusions made by Bharat et al, Lepper et al also discussed the success of the bridging of patients to lung transplantation with ECMO. However, the authors also raised several medical and ethical concerns of this approach, such as disadvantaging patients on the waiting list when high-urgency candidates with ARDS become acceptable LuTx recipients during the pandemic [ 47 ].…”

Section: Lung Transplantation For Sars-cov-2 Infection—associated Ard...mentioning

confidence: 99%

How COVID-19 Affects Lung Transplantation: A Comprehensive Review

Vachtenheim

Novysedlák

Svorcova

et al. 2022

JCM

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Lung transplant (LuTx) recipients are at a higher risk of developing serious illnesses from COVID-19, and thus, we have closely reviewed the consequences of the COVID-19 pandemic on lung transplantation. In most transplant centers, the overall LuTx activity significantly declined and led to a specific period of restricting lung transplantation to urgent cases. Moreover, several transplant centers reported difficulties due to the shortage of ICU capacities. The fear of donor-derived transmission generated extensive screening programs. Nevertheless, reasonable concerns about the unnecessary losses of viable organs were also raised. The overall donor shortage resulted in increased waiting-list mortality, and COVID-19-associated ARDS became an indication of lung transplantation. The impact of specific immunosuppressive agents on the severity of COVID-19 varied. Corticosteroid discontinuation was not found to be beneficial for LuTx patients. Tacrolimus concentrations were reported to increase during the SARS-CoV-2 infection, and in combination with remdesivir, tacrolimus may clinically impact renal functions. Monoclonal antibodies were shown to reduce the risk of hospitalization in SOT recipients. However, understanding the pharmacological interactions between the anti-COVID-19 drugs and the immunosuppressive drugs requires further research.

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Lung transplantation for COVID-19-associated ARDS

Cited by 17 publications

References 5 publications

Lung transplant after 6 months on ECMO support for SARS-CoV-2-induced ARDS complicated by severe antibody-mediated rejection

Lung transplant after 6 months on ECMO support for SARS-CoV-2-induced ARDS complicated by severe antibody-mediated rejection

COVID-19-Associated Lung Fibrosis: Two Pathways and Two Phenotypes, Lung Transplantation, and Antifibrotics

How COVID-19 Affects Lung Transplantation: A Comprehensive Review

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