ABSTRACT
Background: Ex vivo lung perfusion (EVLP) is a safe and effective technique for lung evaluation and reconditioning of marginal donor lungs (DLs). The assessment of the DLs during EVLP is crucial for the transplantability decision making. There are a limited number of studies regarding the radiographic analysis of EVLP lungs. Furthermore, there are only few Xray grading scores available. The Brixia score is a proven radiological score for the severity grading of lung abnormalities with confirmed predictive power of the clinical outcome that was successfully used in pneumonia patients during the COVID-19 pandemic. It was the aim of our study to evaluate the X-ray findings of DLs within EVLP and investigate the prognostic potential of this score regarding transplantability and clinical outcome. Method(s): This is a retrospective observational pilot study. Between 2016 and 2022, a total of 277 double-lung transplantations (DLTx) were performed in our department. X-Rays of the last ten consecutive EVLP-DLs were blindly evaluated regarding the severity of interstitial and alveolar infiltrates and the Brixia score was calculated. Furthermore, the results (transplantability, severe primary graft dysfunction PGD, survival, hospital stay) and EVLP parameters (delta pO2) of these EVLP-DLs cases were analyzed and compared with the Brixia score for each case. Result(s): A range of Brixia score values from min 4 to max 18 was determined. Seven DLs were transplanted (mean delta pO 391 mm Hg, mean Brixia score 6.7) while three were rejected (mean delta pO 211 mm Hg, mean Brixia score 6). The two EVLP-DLs cases with the higher Brixia score (mean 15) were transplanted after EVLP. Postoperative PGD Grade 3 at 48 hours was recorded in one case without correlation to the Brixia score (Brixia score 4). All patients survived hospital discharge with a mean ICU and hospital stay of 9 and 30 days, respectively. Conclusion(s): In our pilot study, the Brixia score did not predict transplantability or postoperative function during EVLP. Additional studies are needed to further evaluate the use and clinical prognostic power of radiologic assessment with this or other scores in the EVLP lung assessment.
ABSTRACT
Introduction: To date, 23 lung transplant recipients have been described with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections worldwide. Eight had severe coronavirus disease 2019 (COVID-19), but none were placed on extracorporeal membrane oxygenation (ECMO) support. We aimed to describe our experience. Methods: Lung transplant recipients who were admitted to our hospital with SARS-CoV-2 infections from the beginning of the pandemia until May 25th, 2020 were included. Clinical charts were retrospectively retrieved and data analysed. Results: Four patients (3 males, 75%) with a median age of 58.5 years (47-66) were admitted for SARS-CoV-2 infections in our center. Three patients had double-lung transplantation for chronic thromboembolic pulmonary hypertension, idiopathic pulmonary fibrosis and cystic fibrosis. One patient had singlelung transplantation for non-specific interstitial pneumonia. SARS-CoV-2 infections were diagnosed by nasopharyngeal swabs in all patients within one month post-transplant (n=2), or after 13 months (n=1) and 15 years (n=1). Dyspnea was present in all patients. Worsening of symptoms occurred in three patients after a median of 8 days (1 to 8) after diagnosis. Imaging showed a highly variable degree of infiltrations. Mechanical ventilation was required in three patients. They all underwent prone positioning. Veno-venous ECMO was required in two patients. In all patients, immunosuppression consisted of prednisone and tacrolimus, while mycophenolate mofetil was stopped. Treatment with hydroxychloroquine was attempted in the first three patients. At last follow-up, one patient was discharged home and one was weaned from mechanical ventilation. Both ECMO supported patients died from multiple organ failure, despite ECMO could be weaned in one patient. Conclusion: A highly variable course of COVID-19 disease was observed in four patients after lung transplantation. More data is needed to better understand prognostic factors and management of this patient cohort.