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Journal of Heart & Lung Transplantation ; 41(4):S481-S482, 2022.
Article in English | Academic Search Complete | ID: covidwho-1783376


Lung transplantation (LTx) can be considered for selected patients suffering from COVID19 ARDS or fibrosis. Besides the lung, the virus also affects the liver and cholangiopathy with progressive biliary liver failure has been described in a substantial rate of COVID19 ARDS survivors. Despite an increasing number of LTx performed worldwide for post-COVID19 ARDS, rates of cholangiopathic liver dysfunction and factors predicting this detrimental late complication are unknown. This retrospective analysis included all LTx performed for post-COVID ARDS or post-COVID fibrosis in our institution between May 2020 and October 2021. Clinical parameters available at the time of listing were compared between LTx recipients who developed irreversible cholangiopathy leading to death or consideration for liver transplantation ('cholangiopathy' group) and patients who had no or only transient liver dysfunction ('control' group). Severe elevation of LFPs was defined as greater than 5 times the upper limit of normal (ULN) of bilirubin, ASAT, ALAT, GGT and AP, respectively. A total of 23 patients were included in the analysis. While 14 (60.9%) showed no or only transient liver dysfunction post-transplant, 9 (39.1%) developed persistent cholangiopathy after LTx. In 4 of these cases, this ultimately led to death, while 2 patients had to be put on the liver transplant wait list. Median time between COVID disease onset and Tx listing (p=0.603) was similar in both study groups. Recipient BMI, previous comorbidities and SOFA score at Tx listing were comparable. Levels of AP, ASAT, ALAT and bilirubin were similar in both groups, however, GGT at the time of listing seemed to predict a later development of cholangiopathy (median 510 vs 211.5 U/L;p=0.062). Moreover, patients with a GGT > 5xULN had a 12 times higher likelihood for the development of post-transplant cholangiopathy compared to those with lower GGT values (OR 95% CI: 0.010 - 0.590). Since severe cholangiopathy is associated with a high mortality after LTx, liver function should be thoroughly assessed in all post-COVID ARDS/fibrosis LTx candidates. In this preliminary observation, we found that GGT at the time of listing was the only parameter which appeared to predict this late complication. Further large-scale studies are required to confirm our findings. [ 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.)

The Journal of Heart and Lung Transplantation ; 40(4, Supplement):S12, 2021.
Article in English | ScienceDirect | ID: covidwho-1141835


Purpose The COVID-19 pandemic has infected millions of people across the world and caused several thousands of deaths. Given advances in extracorporeal life support technology, ECMO for COVID-19 acute respiratory distress syndrome (ARDS) has proven to be successful in sustaining life, however, has left a significant number of patients fully depended on devices and incapable of being weaned. Lung transplantation, as a well-established therapy for end-stage lung disease, has been considered for some patients with COVID-19 ARDS in the absence of lung recovery and the presence of findings suggestive of end-stage lung disease. Methods This is an International collaborative effort to assess the role of lung transplantation in COVID-19 ARDS. There is worldwide representation with centers from US (3), Europe (2) and Asia (1). Patients with COVID-19 ARDS supported on ECMO and/or mechanical ventilation who were deemed unweanable and developed features of end-stage lung disease were evaluated for lung transplantation. We followed ISHLT conventional recipient selection criteria recommendations and a 2 negative COVID-19 PCRs from bronchoalveaolar lavage or viral culture depending on medical urgency. Endpoints We will present demographics, intraoperative challenges, primary graft dysfunction, postoperative complications, survival and functional outcomes of patients with COVID-19 ARDS who underwent lung transplantation. Additionally, referral patterns, reasons for listing denial and waitlist outcomes will be presented. So far, this collaborative group has transplanted 17 patients. There have been no deaths on the waitlist, there was one post-transplant mortality at day 61. Ten patients have been discharged from the hospital and are doing well. Six patients are recovering well however less than 30 days post-transplantation and remain admitted.

The Journal of Heart and Lung Transplantation ; 40(4, Supplement):S368, 2021.
Article in English | ScienceDirect | ID: covidwho-1141822


Purpose Acute respiratory distress syndrome (ARDS) is a rapidly progressive lung disease with a high mortality rate. Although lung transplantation (LTx) is a well-established treatment for a variety of chronic pulmonary diseases, LTx for acute lung failure (due to ARDS) remains controversial. We retrospectively reviewed the post-transplant outcome of ARDS patients from three high-volume European transplant centers. Methods From August 1998 to May 2020, a total of 13 patients (mean age, 29.2 ±3.6 years) transplanted for ARDS, were identified. Demographics and clinical data of these patients were collected and analyzed. Results Viral infection (H1N1, cytomegalovirus, H3N1 and SARS-CoV-2) was the main reason (n=7/13, 53.8%) for ARDS. All patients were admitted to ICU, mechanical ventilated and 11/13 were supported with ECMO during listing, with a median LTx listing time of 3 days (IQR 1.5-14). Postoperatively, median length of mechanical ventilation after LTx was 33 days (IQR 17-52.5), ICU and hospital stay were respectively 39 days (IQR 19.5-58.5) and 54 days (IQR 43.5-127). Prolongation of peripheral postoperative ECMO was required in 7/13 (53.8%) patients with median duration of 2 days (IQR 2-7). The 30-day mortality was 7.7%, median survival 590 days, 1-year and 5-year survival rates were calculated as 71.6% and 54.2%, respectively. Median follow-up time was 536 (IQR 142-1524) days. Conclusion Given the lack of alternative treatment options the herein presented results support the concept of offering LTx to carefully selected ARDS patients.