ABSTRACT
Purpose Solid Organ Transplant recipients (SOT) are at higher risk of SARS-CoV-2 infection. Mortality rates reported between 13 to over 30% in SOT recipients. SARS‐CoV‐2 vaccination may help reduce the morbidity and mortality of COVID‐19 among SOT. There is paucity of literature of SARS-CoV-2 vaccination efficacy in lung transplantation recipients . The purpose of the study was 1) to evaluate SARS-CoV-2 vaccination efficacy & safety in lung transplantation recipients and 2) to assess the need for 3rd booster dose. Methods A retrospective study (from Jan 2021 till Oct 2021) of lung transplantation recipients receiving 2 doses of SARS-CoV-2 vaccination available in India i.e. ChAdOx1 nCoV- 19 Corona Virus Vaccine (Recombinant) or Whole-Virion Inactivated Vero Cell vaccine, was done to evaluate vaccination efficacy and safety. SARS-CoV-2 spike COVID antibodies levels were checked 4 weeks after 2nd dose of vaccination. Local and Systemic reactions to vaccination were noted Results 11 Bilateral lung transplantation recipients and 4 Combined Heart-Lung transplantation recipients received SARS-CoV-2 vaccination. Out of 15 recipients, 11 recipients received ChAdOx1 nCoV- 19 Corona Virus Vaccine (Recombinant) and 4 recipients received Whole-Virion Inactivated Vero Cell vaccine. 12 recipients developed mild pain at vaccination site, 2 recipients developed local tenderness and 1 recipient developed redness at vaccination site as part of local reaction . 5 recipients developed fever, 5 recipients experienced fatigue/bodypain, 2 recipients had vomiting, 2 recipients experienced headache & 1 recipient developed abdominal pain as part of systemic reactions. 8 (53.3%) out of 15 recipients developed significant SARS-CoV-2 spike antibodies level demonstrating vaccination efficacy. 7 (46.6%) recipients demonstrated lower SARS-CoV-2 antibodies titre (Less than cut off values) indicating no significant vaccination efficacy. 1 recipient developed vaccine breakthrough mild infection after 2nd dose. Conclusion Our experience has shown that SARS-CoV-2 vaccination efficacy was demonstrated in nearly 50 % of lung transplantation recipients. The study also showed safety of SARS-CoV-2 vaccines in such immunocompromised subset. However, for those recipients with no vaccination efficacy, utility of 3rd booster dose and at what interval needs more research.
ABSTRACT
Lung transplantation is a definitive treatment option for select end-stage lung disease patients. Post lung transplantation, immunosuppression plays a significant role in a successful outcome. Rejection and infection are commonly encountered where immunosuppression plays an important role. Many immunosuppressive strategies have been designed and their protocols might vary from center to center. This review will focus on these perspectives as well as emerging perspectives during COVID times. © 2021 Wolters Kluwer Medknow Publications. All rights reserved.
ABSTRACT
Purpose The uniqueness and immunological complexity, makes double lung transplantation a challenging high end surgical management for end stage lung disease. Finding the ideal donor organ offers a multitude of logistical barriers., and when that happens, a size mismatch should never be an excuse to waddle the opportunity. The objective of this retrospective review was to observe the clinical outcomes of double lung transplant recipients who underwent non anatomical pulmonary resections. Methods Our team had done 67 double lung transplantations in 2019 and 20 double lung transplants in 2020. A significant reduction by volume was possibly because of lesser donor organ availability in a covid inflicted scenario,thereby creating greater momentum to salvage every donor organ available. A total of sixteen recipients (11 in 2019, 5 in 2020)had undergone size reduction to accomodate oversized lungs. We reviewed the data (case series) of all the sixteen patients who had undergone non anatomical pulmonary resections prior to primary chest closure. Results Out of the 87 double lung transplantation recipients, 16 recipients had to undergo size reduction, 10 recipients underwent resections isolated to right lung, the segments resected were the anterior part of middle lobe, and lower lobe basal and posterior segments.6 patients had both right and left lung resections, the lingulae being the resected segment . Linear endovascular stapples were used for resection, enhanced with bovine pericardium or donor pericardium. Fifteen of the recipients had no post-operative air leak, one had trivial air leak that settled with conservative management and did not require an additional intercostal drainage. Conclusion With good prerequisites, non anatomical resection in an oversized donor organ does not add to the morbidity in the short follow up.
ABSTRACT
Purpose The emergence of the COVID-19 pandemic is unprecedented and poses a challenge in the history of organ transplantation. 2 main decision making challenges related to Transplantation are : starting immunosuppression which potentially can lead to unfavourable outcomes if recipients develop COVID-19 versus deferring transplantation and accepting associated waitlist mortality. Post COVID fibrotic end stage lung disease phenotype on ECMO support as a bridge to LTx (Lung Transplantation) is an emerging indication worldwide but with challenges. We report an impact of COVID pandemic on Lung Transplantation program ,an Indian experience Methods We did a retrospective study from 1st March 2017 till 15 th October 2020. Demographics, Pre-Existing Lung Diseases, Methods of diagnosing SARS-CoV infection, Transplant status and Treatment for SARS-CoV infection were all taken into consideration Results 140 patients have undergone LTx since the time period mentioned. Out of 140 post LTx patients, 2 recipients ( 1.4%) developed SARS-CoV infection out of which 1 patient expired. Out of 24 patients on waitlist from March 2020 to October 2020, 7 patients (29%) developed SARS-CoV Infection. Out of these 7 patients on waitlist, 3 patients (42%) recovered and underwent BLTx (Bilateral) successfully , 3 patients expired (42%) and 1 patient is awaiting LTx. Among these 7 patients awaiting LTx, pre-operatively, 1 had severe PAH (14%), 1 had End Stage Sarcoidosis (14%), 2 had post COVID fibrotic end stage lung disease on ECMO support (28%) and 3 patients had RA-ILD (42%). Among 3 patients while awaiting LTx who expired, 2 patients had underlying post COVID fibrotic end stage lung disease on ECMO support and 1 patient had RA-ILD (Rheumatoid). Conclusion Post Lung Transplantation , few recipients seems to be developing SARS-CoV infection although we require larger retrospective studies for the same. Post COVID fibrotic end stage lung disease phenotype on ECMO support as a bridge to LTx may have significant waitlist mortality and candidacy for LTx should be judiciously determined.