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Montoya-Beltran JS, Ramirez-Herrrera L, Santana YA, Mantilla HA, Forero JF, Franco-Gruntorad GA, Santacruz-Escudero CM. Long Term Veno-Pulmonary Arterial Extracorporeal Membrane Oxygenation as Bridge to Lung Transplantation and Its Challenges: A Case Report. ASAIO J 2024; 70:e75-e77. [PMID: 37815948 DOI: 10.1097/mat.0000000000002071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/12/2023] Open
Abstract
We present a case of a patient with acute respiratory distress syndrome due to severe acute respiratory syndrome coronavirus 2 infection who underwent an extracorporeal membrane oxygenation (ECMO) run of 8 months with various configuration changes, including off-label use of cannulas. The patient eventually underwent successful double lung transplantation after a follow-up of 17 months, demonstrating the successful application of a hybrid approach and careful monitoring in the face of supply shortages during the pandemic. This case highlights the challenges faced by ECMO and transplantation centers during the pandemic and the importance of careful communication and planning to optimize patient outcomes.
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Affiliation(s)
- Juan Sebastian Montoya-Beltran
- From the Anesthesiology Department, Fundación Cardioinfantil-LaCardio, Universidad del Rosario, Bogotá-Colombia, Colombia
| | - Laura Ramirez-Herrrera
- From the Anesthesiology Department, Fundación Cardioinfantil-LaCardio, Universidad del Rosario, Bogotá-Colombia, Colombia
| | - Yimy Alberto Santana
- From the Anesthesiology Department, Fundación Cardioinfantil-LaCardio, Universidad del Rosario, Bogotá-Colombia, Colombia
| | - Hugo Andrés Mantilla
- From the Anesthesiology Department, Fundación Cardioinfantil-LaCardio, Universidad del Rosario, Bogotá-Colombia, Colombia
| | - Julian Francisco Forero
- Radiology Department, Fundación Cardioinfantil-LaCardio, Universidad del Rosario, Bogotá-Colombia, Colombia
| | - German Andres Franco-Gruntorad
- From the Anesthesiology Department, Fundación Cardioinfantil-LaCardio, Universidad del Rosario, Bogotá-Colombia, Colombia
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de Walque JM, de Terwangne C, Jungers R, Pierard S, Beauloye C, Laarbaui F, Dechamps M, Jacquet LM. Potential for recovery after extremely prolonged VV-ECMO support in well-selected severe COVID-19 patients: a retrospective cohort study. BMC Pulm Med 2024; 24:19. [PMID: 38191411 PMCID: PMC10773010 DOI: 10.1186/s12890-023-02836-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/28/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND VenoVenous ExtraCorporeal Membrane Oxygenation (VV-ECMO) has been widely used as supportive therapy for severe respiratory failure related to Acute Respiratory Distress Syndrome (ARDS) due to coronavirus 2019 (COVID-19). Only a few data describe the maximum time under VV-ECMO during which pulmonary recovery remains possible. The main objective of this study is to describe the outcomes of prolonged VV-ECMO in patients with COVID-19-related ARDS. METHODS This retrospective study was conducted at a tertiary ECMO center in Brussels, Belgium, between March 2020 and April 2022. All adult patients with ARDS due to COVID-19 who were managed with ECMO therapy for more than 50 days as a bridge to recovery were included. RESULTS Fourteen patients met the inclusion criteria. The mean duration of VV-ECMO was 87 ± 29 days. Ten (71%) patients were discharged alive from the hospital. The 90-day survival was 86%, and the one-year survival was 71%. The evolution of the patients was characterized by very impaired pulmonary compliance that started to improve slowly and progressively on day 53 (± 25) after the start of ECMO. Of note, four patients improved substantially after a second course of steroids. CONCLUSIONS There is potential for recovery in patients with very severe ARDS due to COVID-19 supported by VV-ECMO for up to 151 days.
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Affiliation(s)
- Jean-Marc de Walque
- Department of Cardiovascular Intensive Care, Cliniques Universitaires Saint Luc, Catholic University of Louvain, Avenue Hippocrate 10, Brussels, 1200, Belgium
- Emergency Department, Universitair Ziekenhuis Brussels, Brussels, Belgium
| | - Christophe de Terwangne
- Department of Cardiovascular Intensive Care, Cliniques Universitaires Saint Luc, Catholic University of Louvain, Avenue Hippocrate 10, Brussels, 1200, Belgium
| | - Raphaël Jungers
- Institute for Information and Communication Technologies, Electronics, and Applied Mathematics, Université Catholique de Louvain, Louvain-La-Neuve, Belgium
| | - Sophie Pierard
- Department of Cardiovascular Intensive Care, Cliniques Universitaires Saint Luc, Catholic University of Louvain, Avenue Hippocrate 10, Brussels, 1200, Belgium
- Pôle de Recherche Cardiovasculaire, Institutde Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Christophe Beauloye
- Department of Cardiovascular Intensive Care, Cliniques Universitaires Saint Luc, Catholic University of Louvain, Avenue Hippocrate 10, Brussels, 1200, Belgium
- Pôle de Recherche Cardiovasculaire, Institutde Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Fatima Laarbaui
- Department of Cardiovascular Intensive Care, Cliniques Universitaires Saint Luc, Catholic University of Louvain, Avenue Hippocrate 10, Brussels, 1200, Belgium
| | - Melanie Dechamps
- Department of Cardiovascular Intensive Care, Cliniques Universitaires Saint Luc, Catholic University of Louvain, Avenue Hippocrate 10, Brussels, 1200, Belgium
- Pôle de Recherche Cardiovasculaire, Institutde Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Luc Marie Jacquet
- Department of Cardiovascular Intensive Care, Cliniques Universitaires Saint Luc, Catholic University of Louvain, Avenue Hippocrate 10, Brussels, 1200, Belgium.
- Pôle de Recherche Cardiovasculaire, Institutde Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium.
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Mang S, Karagiannidis C, Lepper PM. [When mechanical ventilation fails-Venovenous extracorporeal membrane oxygenation]. INNERE MEDIZIN (HEIDELBERG, GERMANY) 2023; 64:922-931. [PMID: 37721597 DOI: 10.1007/s00108-023-01586-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/14/2023] [Indexed: 09/19/2023]
Abstract
Venovenous extracorporeal membrane oxygenation (VV-ECMO) is predominantly being used as a rescue strategy in patients with acute lung failure, suffering from severe oxygenation and/or decarboxylation impairment. Cannulas introduced into the central veins lead blood through a membrane oxygenator in which it is oxygenated via sweep gas (pO2 up to 600 mm Hg) flow, eliminating CO2. According to the largest randomized studies carried out so far, the two most important indications for VV-ECMO are hypoxic respiratory failure (paO2 < 80 mm Hg for more than 6 h) and refractory hypercapnia (pH < 7.25 und pCO2 > 60 mm Hg with a breathing frequency of >30/min) despite optimal protective mechanical ventilation settings (ARDS, Δp < 14 mbar, plateau pressure < 30 mbar, tidal volume VT < 6 ml/kg idealized body weight). Relative contraindications are life-limiting comorbidities and terminal pulmonary diseases that cannot be treated by lung transplantation. Advanced patient age is not regarded as an absolute contraindication, though it highly impacts ARDS survival rates, especially for pneumonia associated with coronavirus disease 2019 (COVID-19). The most frequent complications of VV-ECMO include bleeding, thrombus formation and rare cases of cannula-associated infections. Its use in nonintubated patients (awake ECMO) is possible in specific cases and has proven valuable as a bridge to lung transplant approach. Some ECMO centers offer cannulation of a patient at primary care hospitals, facilitating subsequent transport to the center (ECMO transport). The COVID-19 pandemic not only caused the number of VV-ECMO runs to skyrocket but has also drawn public attention to this extracorporeal procedure. Strict quality control to improve vvECMO outcomes according to the German hospital reform is urgently needed, especially so since the technique has a high demand in resources and bears significant risks when performed by untrained personnel.
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Affiliation(s)
- Sebastian Mang
- Klinik für Innere Medizin V - Pneumologie, Allergologie, Intensivmedizin, Notfallmedizin, ECLS-Center Saar, Universitätsklinik des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland
| | - Christian Karagiannidis
- Lungenklinik Köln-Merheim, Kliniken der Stadt Köln gGmbH, Köln, Deutschland
- Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - Philipp M Lepper
- Klinik für Innere Medizin V - Pneumologie, Allergologie, Intensivmedizin, Notfallmedizin, ECLS-Center Saar, Universitätsklinik des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland.
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Alessandri F, Di Nardo M, Ramanathan K, Brodie D, MacLaren G. Extracorporeal membrane oxygenation for COVID-19-related acute respiratory distress syndrome: a narrative review. J Intensive Care 2023; 11:5. [PMID: 36755270 PMCID: PMC9907879 DOI: 10.1186/s40560-023-00654-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 01/30/2023] [Indexed: 02/10/2023] Open
Abstract
A growing body of evidence supports the use of extracorporeal membrane oxygenation (ECMO) for severe acute respiratory distress syndrome (ARDS) refractory to maximal medical therapy. ARDS may develop in a proportion of patients hospitalized for coronavirus disease 2019 (COVID-19) and ECMO may be used to manage patients refractory to maximal medical therapy to mitigate the risk of ventilator-induced lung injury and provide lung rest while awaiting recovery. The mortality of COVID-19-related ARDS was variously reassessed during the pandemic. Veno-venous (VV) ECMO was the default choice to manage refractory respiratory failure; however, with concomitant severe right ventricular dysfunction, venoarterial (VA) ECMO or mechanical right ventricular assist devices with extracorporeal gas exchange (Oxy-RVAD) were also considered. ECMO has also been used to manage special populations such as pregnant women, pediatric patients affected by severe forms of COVID-19, and, in cases with persistent and seemingly irreversible respiratory failure, as a bridge to successful lung transplantation. In this narrative review, we outline and summarize the most recent evidence that has emerged on ECMO use in different patient populations with COVID-19-related ARDS.
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Affiliation(s)
- Francesco Alessandri
- grid.7841.aDepartment of General and Specialistic Surgery, Sapienza University of Rome, Rome, Italy
| | - Matteo Di Nardo
- grid.414125.70000 0001 0727 6809Pediatric Intensive Care Unit, Children’s Hospital Bambino Gesù, IRCCS, Rome, Italy
| | - Kollengode Ramanathan
- grid.412106.00000 0004 0621 9599Cardiothoracic Intensive Care Unit, National University Hospital, Singapore, Singapore
| | - Daniel Brodie
- grid.21729.3f0000000419368729Columbia University College of Physicians and Surgeons/New York-Presbyterian Hospital, New York, NY USA ,grid.239585.00000 0001 2285 2675Center for Acute Respiratory Failure, Columbia University Medical Center, New York, NY USA
| | - Graeme MacLaren
- Cardiothoracic Intensive Care Unit, National University Hospital, Singapore, Singapore.
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Commentary on "Lung Transplantation for COVID-19 Pulmonary Sequelae": Beautiful Story, Already History? Transplantation 2023; 107:305-306. [PMID: 36476617 PMCID: PMC9875793 DOI: 10.1097/tp.0000000000004415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Editorial: Advances in cardiovascular medicine: debates and controversies. Curr Opin Anaesthesiol 2023; 36:1-4. [PMID: 36550600 DOI: 10.1097/aco.0000000000001216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Rathod SN, Bardowski L, Tse I, Churyla A, Fiehler M, Malczynski M, Qi C, Tanna SD, Bulger C, Al-Qamari A, Oakley R, Zembower TR. Vancomycin-resistant Enterococcus outbreak in a pre- and post-cardiothoracic transplant population: Impact of discontinuing multidrug-resistant organism surveillance during the coronavirus disease 2019 pandemic. Transpl Infect Dis 2022; 24:e13972. [PMID: 36169219 DOI: 10.1111/tid.13972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 08/31/2022] [Accepted: 09/16/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Many institutions suspended surveillance and contact precautions for multidrug-resistant organisms (MDROs) at the outset of the coronavirus disease 2019 (COVID-19) pandemic due to a lack of resources. Once our institution reinstated surveillance in September 2020, a vancomycin-resistant Enterococcus (VRE) faecium outbreak was detected in the cardiothoracic transplant units, a population in which we had not previously detected outbreaks. METHODS An outbreak investigation was conducted using pulsed-field gel electrophoresis for strain typing and electronic medical record review to determine the clinical characteristics of involved patients. The infection prevention (IP) team convened a multidisciplinary process improvement team comprised of IP, cardiothoracic transplant nursing and medical leadership, environmental services, and the microbiology laboratory. RESULTS Between December 2020 and March 2021, the outbreak involved thirteen patients in the cardiothoracic transplant units, four index cases, and nine transmissions. Of the 13, seven (54%) were on the transplant service, including heart and lung transplant recipients, patients with ventricular assist devices, and a patient on extracorporeal membrane oxygenation as a bridge to lung transplantation. Four of 13 (31%) developed a clinical infection. DISCUSSION Cardiothoracic surgery/transplant patients may have a similar risk for VRE-associated morbidity as abdominal solid organ transplant and stem cell transplant patients, highlighting the need for aggressive outbreak management when VRE transmission is detected. Our experience demonstrates an unintended consequence of discontinuing MDRO surveillance in this population and highlights a need for education, monitoring, and reinforcement of foundational infection prevention measures to ensure optimal outcomes.
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Affiliation(s)
- Shardul N Rathod
- Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Laura Bardowski
- Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Isabella Tse
- Cardiac, Vascular, and Thoracic Stepdown, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Andrei Churyla
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, Illinois, USA
| | - Monica Fiehler
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, Illinois, USA
| | - Michael Malczynski
- Department of Pathology, Northwestern University Feinberg School of Medicine, Clinical Microbiology Laboratory, Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Chao Qi
- Department of Pathology, Northwestern University Feinberg School of Medicine, Clinical Microbiology Laboratory, Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Sajal D Tanna
- Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Christine Bulger
- Department of Environmental Services and Patient Escort, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Abbas Al-Qamari
- Division of Cardiac Surgery, Department of Surgery, Bluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine and Northwestern Medicine, Chicago, Illinois, USA.,Department of Anesthesiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robin Oakley
- Cardiac Transplant Intensive Care Unit, Northwestern Memorial Hospital, Chicago, Illinois, USA
| | - Teresa R Zembower
- Department of Healthcare Epidemiology and Infection Prevention, Northwestern Memorial Hospital, Chicago, Illinois, USA.,Department of Pathology, Northwestern University Feinberg School of Medicine, Clinical Microbiology Laboratory, Northwestern Memorial Hospital and Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Medicine, Division of Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Haslbauer JD, Bratic-Hench I, Cima K, Luger AK, Schmitz K, Augustin F, Krapf C, Hoefer D, Tancevski I, Tzankov A, Löffler-Ragg J. Interstitial Pulmonary Fibrosis and Extensive Dendriform Ossification with Persistent Viral Load: A Rare Presentation of Post-COVID-19 Condition in Need of Lung Transplantation. Pathobiology 2022; 90:138-146. [PMID: 35835004 PMCID: PMC10129030 DOI: 10.1159/000525457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 06/04/2022] [Indexed: 11/19/2022] Open
Abstract
The incidence, presentation, and predisposing factors of post-acute sequelae of COVID-19 (PASC) are currently poorly understood. Lung explants may provide a rare insight into terminal SARS-CoV-2-associated lung damage and its pathophysiology. A 62-year-old man presented with progressively worsening respiratory symptoms after recovering from mild COVID-19 3 months earlier. No underlying pulmonary comorbidities were reported. A chest CT revealed bilateral extensive ground-glass and reticular opacities, suspicious of pulmonary fibrosis. Despite initial high-dose glucocorticoid therapy, the interstitial lung disease progressed, and after exhausting all viable therapeutic options, bilateral lung transplantation was successfully conducted. Histological analysis revealed extensive end-stage interstitial fibrosis with diffuse dendriform ossification and bronchiolar and transitional cell metaplasia. Signs of interstitial remodeling such as an increased interstitial collagen deposition, a pathological accumulation of CD163+/CD206+ M2-polarized macrophages with an increased expression of phosphorylated ERK, and an increased density of CD105+ newly formed capillaries were observed. qRT-PCR and immunohistochemistry for SARS-CoV-2 N-protein in the endothelium of medium-sized vessels confirmed a persistence of SARS-CoV-2. Our findings highlight a highly unusual presentation of SARS-CoV-2-associated lung fibrosis, implying that incomplete viral clearance in the vascular compartment may play a vital pathophysiological role in the development of PASC.
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Affiliation(s)
- Jasmin Dionne Haslbauer
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland,
| | - Ivana Bratic-Hench
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Katharina Cima
- Department of Internal Medicine II (Infectiology, Rheumatology, Pneumology), Medical University of Innsbruck, Innsbruck, Austria
| | | | - Katja Schmitz
- Institute of Pathology, Innpath, Tyrolean State Clinics, Innsbruck, Austria
| | - Florian Augustin
- Department of Visceral, Transplantation and Thoracic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Christoph Krapf
- Department of Thoracic and Cardiovascular Surgery, University Hospital Innsbruck, Innsbruck, Austria
| | - Daniel Hoefer
- Department of Thoracic and Cardiovascular Surgery, University Hospital Innsbruck, Innsbruck, Austria
| | - Ivan Tancevski
- Department of Internal Medicine II (Infectiology, Rheumatology, Pneumology), Medical University of Innsbruck, Innsbruck, Austria
| | - Alexandar Tzankov
- Pathology, Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Judith Löffler-Ragg
- Department of Internal Medicine II (Infectiology, Rheumatology, Pneumology), Medical University of Innsbruck, Innsbruck, Austria
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COVID-19-Associated Lung Fibrosis: Two Pathways and Two Phenotypes, Lung Transplantation, and Antifibrotics. TRANSPLANTOLOGY 2022. [DOI: 10.3390/transplantology3030024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
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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Vachtenheim J, Novysedlak R, Svorcova M, Lischke R, Strizova Z. How COVID-19 Affects Lung Transplantation: A Comprehensive Review. J Clin Med 2022; 11:jcm11123513. [PMID: 35743583 PMCID: PMC9225085 DOI: 10.3390/jcm11123513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/08/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023] Open
Abstract
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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Affiliation(s)
- Jiri Vachtenheim
- Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, 150 06 Prague, Czech Republic; (J.V.J.); (R.N.); (M.S.); (R.L.)
| | - Rene Novysedlak
- Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, 150 06 Prague, Czech Republic; (J.V.J.); (R.N.); (M.S.); (R.L.)
| | - Monika Svorcova
- Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, 150 06 Prague, Czech Republic; (J.V.J.); (R.N.); (M.S.); (R.L.)
| | - Robert Lischke
- Prague Lung Transplant Program, 3rd Department of Surgery, First Faculty of Medicine, Charles University, University Hospital Motol, 150 06 Prague, Czech Republic; (J.V.J.); (R.N.); (M.S.); (R.L.)
| | - Zuzana Strizova
- Department of Immunology, Second Faculty of Medicine, Charles University, University Hospital Motol, 150 06 Prague, Czech Republic
- Correspondence: ; Tel.: +420-604712471
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Petrini C, Peritore D, Riva L, Floridia G, Gainotti S, Grossi P, Castiglione A, Beretta M, Rea F, Nosotti M, Lombardini L, Cardillo M. POST COVID-19 LUNG TRANSPLANTATION ITALIAN PIVOTAL PROTOCOL: SOME ETHICAL CONSIDERATIONS. Transplant Proc 2022; 54:1524-1527. [PMID: 35863996 PMCID: PMC9156951 DOI: 10.1016/j.transproceed.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 05/04/2022] [Accepted: 05/04/2022] [Indexed: 11/16/2022]
Abstract
SARS‑CoV‑2 mostly affects the respiratory system with clinical patterns ranging from the common cold to fatal pneumonia. During the first wave of the COVID-19 pandemic, owing to the high number of patients who were infected with SARS‑CoV‑2 and subsequently recovered, it has been shown that some patients with post–COVID-19 terminal respiratory failure need lung transplantation for survival. There is increasing evidence coming from worldwide observations that this procedure can be performed successfully in post–COVID-19 patients. However, owing to the scarcity of organs, there is a need to define the safety and efficacy of lung transplant for post–COVID-19 patients as compared to patients waiting for a lung transplant for other pre-existing conditions, in order to ensure that sound ethical criteria are applied in organ allocation. The Milan's Policlinic Lung Transplant Surgery Unit, with the revision of the National Second Opinion for Infectious Diseases and the contribution of the Italian Lung Transplant Centres and the Italian National Transplant Centre, set up a pivotal observational protocol for the lung transplant of patients infected and successively turned negative for SARS‑CoV‑2, albeit with lung consequences such as acute respiratory distress syndrome or some chronic interstitial lung disease. The protocol was revised and approved by the Italian National Institute of Health Ethics Committee. Description of the protocol and some ethical considerations are reported in this article.
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Prakash Yadava O. Lung transplant for COVID-19—a bone of contention! Indian J Thorac Cardiovasc Surg 2022; 38:205-206. [PMID: 35614975 PMCID: PMC9123854 DOI: 10.1007/s12055-022-01372-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Urlik M, Stącel T, Latos M, Pasek P, Pióro A, Zawadzki F, Gmerek M, Księżopolska P, Przybyłowski P, Ochman M. Lung transplantation as a treatment for patients with end-stage respiratory failure due to Coronavirus disease of 2019 (COVID-19). Transplant Proc 2022; 54:908-912. [PMID: 35725595 PMCID: PMC8995202 DOI: 10.1016/j.transproceed.2022.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/08/2022] [Accepted: 03/14/2022] [Indexed: 11/24/2022]
Abstract
Background COVID-19 may lead to development of irreversible acute respiratory distress syndrome. Some patients sustain severe respiratory failure after infection subsides. They may require lung transplant as a last resort treatment. The aim of the study is to assess the effect and feasibility of lung transplant as a treatment for patients with severe irreversible respiratory failure due to COVID-19. Methods This retrospective study pertains to analysis of 119 patients in critical condition who were referred to Lung Transplant Ward (Zabrze, Poland). between July 2020 and June 2021 after developing respiratory failure requiring extracorporeal membrane oxygenation, invasive ventilation, or both, as well as a few patients on high-flow oxygen therapy. Inclusion criteria for referral were confirmed lack of viral disease and exhaustion of other therapeutic options. Results Of the referred patients, 21.84% were disqualified from such treatment owing to existing contraindications. Among the suitable patients, 75.8% died without transplant. Among all patients who were qualified for lung transplant, only 9 patients became double lung transplant recipients. Intraoperative mortality for this procedure was 33%. Four patients were discharged after the procedure and are currently self-reliant with full respiratory capacity. Conclusions Patients with severe irreversible respiratory failure after COVID-19 present significantly high mortality without lung transplant. This procedure may present satisfactory results but must be performed in a timely fashion owing to critical condition and scarcity of lung donors, only aggravated around the time of peak infection waves.
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Lindstedt S, Grins E, Larsson H, Nilsson J, Akbarshahi H, Silva I, Hyllen S, Wagner D, Sjögren J, Hansson L, Ederoth P, Gustafsson R. Lung transplant after 6 months on ECMO support for SARS-CoV-2-induced ARDS complicated by severe antibody-mediated rejection. BMJ Open Respir Res 2021; 8:8/1/e001036. [PMID: 34544734 PMCID: PMC8453592 DOI: 10.1136/bmjresp-2021-001036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 09/03/2021] [Indexed: 12/28/2022] Open
Abstract
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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Affiliation(s)
- Sandra Lindstedt
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital Lund, Lund, Sweden .,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Edgar Grins
- Department of Cardiothoracic Anaesthesia and Intensive Care, Lund University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Hillevi Larsson
- Department of Pulmonology and Transplantation, Lund University Hospital, Lund, Sweden
| | - Johan Nilsson
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital Lund, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Hamid Akbarshahi
- Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Pulmonology and Transplantation, Lund University Hospital, Lund, Sweden
| | - Iran Silva
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,Department of Experimental Medical Sciences, Lung Bioengineering and Regeneration, Lund University, Lund, Sweden
| | - Snejana Hyllen
- Department of Cardiothoracic Anaesthesia and Intensive Care, Lund University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Darcy Wagner
- Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden.,Lund Stem Cell Center, Lund University, Lund, Sweden
| | - Johan Sjögren
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital Lund, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Lennart Hansson
- Department of Pulmonology and Transplantation, Skåne University Hospital Lund, Lund, Sweden
| | - Per Ederoth
- Department of Cardiothoracic Anaesthesia and Intensive Care, Lund University Hospital, Lund, Sweden.,Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Ronny Gustafsson
- Department of Cardiothoracic Surgery and Transplantation, Skåne University Hospital Lund, Lund, Sweden
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