ABSTRACT
The obesity epidemic is an on-going barrier to transplant. A body mass index (BMI) ≥35 kg/m2 is considered a risk factor for poor post-transplant outcomes. This presents a challenge to end-stage lung disease patients that often struggle to maintain physical activity secondary to high supplemental oxygen requirements. This can impede weight loss and delay time to listing, especially for patients with a BMI of 30-40 who do not qualify for or who do not wish to undergo bariatric surgery. In this case series, we describe our experience using Semaglutide for weight loss. Utilizing chart review, we identified 3 patients with obesity that utilized semaglutide for weight loss and diabetes management. All were followed by a licensed dietitian and engaged in exercise as tolerated. Our BMI criteria includes BMI ≤32 and ≤30 for evaluation and listing respectively. Exceptions we made at the discretion of the multidisciplinary team. All patients experienced weight loss after starting semaglutide averaging 9kg over an average period of 89 days. Listing for patient 1 was delayed due to COVID-19 infection. Patient 3 lost 6kg while being on semaglutide for 9 days therefore the decision was made to list the patient, as it was anticipated he would continue to lose weight. The medication was well tolerated with no reported side effects. Additional details are shown in table 1. Semaglutide presents an acceptable method for weight loss assistance in patients undergoing lung transplant evaluation. Expedited weight loss can decrease time from referral to listing. Limitations to this weight loss strategy would be medication access in non-diabetic obese patients. Next steps to validate this observed benefit is to launch a formal prospective program that includes this medication as an option in transplant evaluation. [ABSTRACT 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 abstract 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 abstract. (Copyright applies to all Abstracts.)
ABSTRACT
Purpose Anti-severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) vaccination is recommended by AST, ISHLT, and CDC in all transplant recipients. Lung transplant recipients (LTR) are at a higher risk of developing severe symptoms due to higher immunosuppression (IS) and baseline compromised graft function. Limited antibody response to messenger RNA (mRNA) vaccines has been reported in LTR, with the majority mounting a response after the 2nd dose. In this series, 3 patients developed new and significant respiratory compromise after their 2nd vaccine dose consistent with antibody mediated rejection (AMR). To our knowledge, this is the first published case series of vaccine induced rejection in LTR. Methods Retrospective chart review of our cohort showed 46% fully vaccinated and an additional 2.5% partially vaccinated patients. Three fully vaccinated patients with approved mRNA vaccines (2 Moderna, 1 Pfizer-BioNTech) were identified after developing severe respiratory compromise post 2nd vaccine dose. Evaluation revealed AMR as the underlying etiology. Results All patients were female, ages 50-70 years old, between 6 months and 2 years post-transplant. No previous rejection episodes. All were on standard IS as per institution protocols. Two were hospitalized with hypoxic respiratory failure within 2 weeks of their 2nd vaccine dose. The 3rd was seen at clinic for milder similar symptoms, later progressing and requiring supplemental oxygen (O2) and hospitalization. Imaging showed new lung infiltrates, infectious work up was negative. Biopsies did not show any cellular rejection. All developed new DSAs and received treatment for AMR with plasmapheresis, IVIg, and Rituximab. Two recovered their lung function and are off supplemental O2, the 3rd did not and is re-listed for transplant. Conclusion While LTR have a diminished response to SARS-CoV-2 vaccines making them more vulnerable to the disease, their immune system's response may not always be clear. We report three cases of patients developing severe AMR from new DSAs that appear to be triggered by the COVID-19 vaccine. This vaccine responses should be collected in a database where each case can be investigated to help better understand the mechanism behind them and hopefully identifying LTR at risk. This can then be used to modify vaccination strategies and aid in preventing adverse outcomes in this vulnerable group of patients.
ABSTRACT
Purpose The aim of this study was to describe the clinical course and outcomes of four lung transplant recipients in the CD10 trial (NCT04343651): use of leronlimab (PRO 140), a novel humanized IgG4,κ monoclonal antibody to CCR5, for the treatment of mild-moderate COVID-19 illness. Methods Four eligible lung transplant recipients with positive SARS-CoV2 PCR testing and mild-moderate illness received placebo or 1-2 weekly 700mg subcutaneous doses of leronlimab. Demographics, laboratory, radiologic, and clinical outcomes were reviewed. Results Between March and May 2020, three single-lung transplant recipients received leronlimab and one received placebo for mild-moderate disease. The total median age was 63.5 years (range 59.0-73.0) with equal male and female participants. The median duration between transplant and COVID-19 diagnosis was 409 days (range 149-631). Three patients (75%) required hospitalization for a median of 3 days (range 2-4);however, none required mechanical ventilation or positive pressure support. Baseline median CRP and CD4/CD8 counts were 4.4 mg/dL (range 1.3-15.3) and 1.16 (range 0.73-1.84) respectively, and normalized after one week of therapy. Abnormal imaging findings at the time of diagnosis were identified in native lungs (Figure 1). Baseline median FEV1, FVC, and 6MWT were 2.07 L (range 0.76-3.4), 2.73 L (range 1.46-4.09), and 402 m (range 247-496) with median change in baseline of -1.7%, -2.8%, and 3.8% respectively as of full clinical recovery through September 1, 2020. There were no episodes of acute rejection, by clinical evaluation or biopsy, or other known adverse events noted after leronlimab administration. Conclusion No definitive adverse events, disruptions of immunosuppression, or episodes of acute rejection or BOS were identified following leronlimab administration in a small series of lung transplant patients. Leronlimab may prove a safe and effective therapy for the restoration of immune homeostasis associated with COVID-19 illness in the future.