ABSTRACT
Lung transplantation (LT) quickly emerged as an accepted therapy for respiratory failure due to COVID. Since March 2020, progress had been made in therapeutics, vaccines, and other preventive measures. Variants with milder disease also emerged over the course of the pandemic. We aimed to examine patient demographics, illness severity, and frequency of listing and LT for respiratory failure due to COVID over time in the U.S. We retrospectively queried the OPTN database, administered by UNOS. We included all adults aged 18 years and older who were listed for LT from March 2020 to June 2022 with primary diagnoses of COVID-19 (1616 (COVID 19-ARDS), 1617 (COVID-19 pulmonary fibrosis) or ARDS (402). We included those with a diagnosis of ARDS to avoid unintentional exclusion of patients with respiratory failure due to COVID-19, particularly at the onset of the pandemic. 536 patients were listed, with 431 patients (80%) undergoing LT, between March 2020 to June 2022 for primary diagnoses of COVID ARDS, COVID-pulmonary fibrosis, and ARDS. The listed patients were median age of 51 years-old, mostly male (72%), and were most commonly Caucasian (53%). They were most frequently listed for double lung transplant (83%) and were in the ICU (77%) with 51% on ECMO and 35% on MV at the time of listing. Nine percent on the wait list (WL) died prior to LT. Out of 57 patients (10%) with other outcome, 45% remained on WL while 42% were removed from WL for clinical improvement. Over the course of the pandemic, increasingly, patients were outside of the ICU with decreased rates of MV and ECMO at the time of listing and transplant. LT continued to be performed for respiratory failure due to COVID-19 as of June 2022. There had been no official guidelines delineating the usage of the diagnoses COVID ARDS vs. COVID-pulmonary fibrosis. However, it appears that patients listed for COVID ARDS had a significantly higher median LAS score;were younger;were more likely to be in the ICU, and on MV and ECMO at time of listing and transplant. [ FROM AUTHOR] Copyright of Journal of Heart & Lung Transplantation is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)
ABSTRACT
Introduction: Pulmonary alveolar proteinosis (PAP) is a rare disorder that results from impaired clearance of surfactant. The classic radiographic appearance on chest computed tomography (CT) is patchy, ground glass opacities with interlobular septal thickening frequently described as a “crazy paving” pattern. Although the diagnosis can sometimes be established by transbronchial biopsy, surgical lung biopsy is the gold standard. There are few case reports of PAP in lung transplant recipients. Case Description: We report the case of a 57 year-old man with chronic hypersensitivity pneumonitis who underwent left single lung transplantation. His post-operative course was complicated by persistent Coronavirus HKU1 infection or shedding. Approximately one year after transplant, he was diagnosed with PAP by surgical lung biopsy showing periodic acid-Schiff (PAS)-positive lipoproteinaceous material within alveoli. While whole lung lavage is the mainstay of treatment for PAP, given his severely fibrotic native lung and significant hypoxemia, he was successfully treated with bronchoscopic lobar lavage of his allograft in two sessions one week apart. Unfortunately, he was later was diagnosed with peritoneal mesothelioma. Discussion: We highlight the challenges in the diagnosis, discuss potential etiologies and describe a unique therapy of this rare disorder in lung transplant recipients. In addition to more common etiologies, such as infection, pulmonary edema, and allograft rejection, PAP should be considered in the differential diagnosis for lung transplant recipients presenting with hypoxemia and ground glass opacities in their allograft. In some cases, such as this one, PAP can be the initial manifestation prior to the diagnosis of a malignancy;however, while hematologic malignancies are commonly associated with PAP, there is only one prior reported case of a patient with long-standing PAP and later diagnosis of mesothelioma. In addition to the association between PAP and mesothelioma, this case suggests the possibility of an association between PAP and transplant immunosuppression or persistent Coronavirus infection/shedding. Therapeutic bronchoscopic lobar lung lavage can be an effective intervention in lieu of whole-lung lavage, particularly for single lung transplant recipients who would not tolerate whole-lung lavage.