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Early outcomes after lung transplantation for severe COVID-19: a series of the first consecutive cases from four countries.
Bharat, Ankit; Machuca, Tiago N; Querrey, Melissa; Kurihara, Chitaru; Garza-Castillon, Rafael; Kim, Samuel; Manerikar, Adwaiy; Pelaez, Andres; Pipkin, Mauricio; Shahmohammadi, Abbas; Rackauskas, Mindaugas; Kg, Suresh Rao; Balakrishnan, K R; Jindal, Apar; Schaheen, Lara; Hashimi, Samad; Buddhdev, Bhuvin; Arjuna, Ashwini; Rosso, Lorenzo; Palleschi, Alessandro; Lang, Christian; Jaksch, Peter; Budinger, G R Scott; Nosotti, Mario; Hoetzenecker, Konrad.
  • Bharat A; Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA. Electronic address: Ankit.Bh
  • Machuca TN; Department of Surgery, Division of Thoracic Surgery, University of Florida, Gainesville, FL, USA.
  • Querrey M; Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
  • Kurihara C; Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
  • Garza-Castillon R; Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
  • Kim S; Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
  • Manerikar A; Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
  • Pelaez A; Department of Surgery, Division of Thoracic Surgery, University of Florida, Gainesville, FL, USA.
  • Pipkin M; Department of Surgery, Division of Thoracic Surgery, University of Florida, Gainesville, FL, USA.
  • Shahmohammadi A; Department of Surgery, Division of Thoracic Surgery, University of Florida, Gainesville, FL, USA.
  • Rackauskas M; Department of Surgery, Division of Thoracic Surgery, University of Florida, Gainesville, FL, USA.
  • Kg SR; Department of Pulmonary, Critical Care and Sleep Medicine, MGM Healthcare, Aminjikarai, Chennai, India.
  • Balakrishnan KR; Department of Pulmonary, Critical Care and Sleep Medicine, MGM Healthcare, Aminjikarai, Chennai, India.
  • Jindal A; Department of Pulmonary, Critical Care and Sleep Medicine, MGM Healthcare, Aminjikarai, Chennai, India.
  • Schaheen L; Norton Thoracic Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
  • Hashimi S; Norton Thoracic Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
  • Buddhdev B; Norton Thoracic Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
  • Arjuna A; Norton Thoracic Institute, St Joseph's Hospital and Medical Center, Phoenix, AZ, USA.
  • Rosso L; Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Palleschi A; Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Lang C; Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
  • Jaksch P; Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
  • Budinger GRS; Division of Thoracic Surgery, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
  • Nosotti M; Thoracic Surgery and Lung Transplantation Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
  • Hoetzenecker K; Department of Thoracic Surgery, Medical University of Vienna, Vienna, Austria.
Lancet Respir Med ; 9(5): 487-497, 2021 05.
Article in English | MEDLINE | ID: covidwho-1537196
Semantic information from SemMedBD (by NLM)
1. Lung Transplantation TREATS COVID-19
Subject
Lung Transplantation
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TREATS
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COVID-19
2. Lung LOCATION_OF Terminal illness
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Terminal illness
3. Lung Transplantation TREATS Terminal illness
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Terminal illness
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11. Double lung transplant TREATS Acute respiratory distress syndrome due to disease caused by Severe acute respiratory syndrome coronavirus 2
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ABSTRACT

BACKGROUND:

Lung transplantation is a life-saving treatment for patients with end-stage lung disease; however, it is infrequently considered for patients with acute respiratory distress syndrome (ARDS) attributable to infectious causes. We aimed to describe the course of disease and early post-transplantation outcomes in critically ill patients with COVID-19 who failed to show lung recovery despite optimal medical management and were deemed to be at imminent risk of dying due to pulmonary complications.

METHODS:

We established a multi-institutional case series that included the first consecutive transplants for severe COVID-19-associated ARDS known to us in the USA, Italy, Austria, and India. De-identified data from participating centres-including information relating to patient demographics and pre-COVID-19 characteristics, pretransplantation disease course, perioperative challenges, pathology of explanted lungs, and post-transplantation outcomes-were collected by Northwestern University (Chicago, IL, USA) and analysed.

FINDINGS:

Between May 1 and Sept 30, 2020, 12 patients with COVID-19-associated ARDS underwent bilateral lung transplantation at six high-volume transplant centres in the USA (eight recipients at three centres), Italy (two recipients at one centre), Austria (one recipient), and India (one recipient). The median age of recipients was 48 years (IQR 41-51); three of the 12 patients were female. Chest imaging before transplantation showed severe lung damage that did not improve despite prolonged mechanical ventilation and extracorporeal membrane oxygenation. The lung transplant procedure was technically challenging, with severe pleural adhesions, hilar lymphadenopathy, and increased intraoperative transfusion requirements. Pathology of the explanted lungs showed extensive, ongoing acute lung injury with features of lung fibrosis. There was no recurrence of SARS-CoV-2 in the allografts. All patients with COVID-19 could be weaned off extracorporeal support and showed short-term survival similar to that of transplant recipients without COVID-19.

INTERPRETATION:

The findings from our report show that lung transplantation is the only option for survival in some patients with severe, unresolving COVID-19-associated ARDS, and that the procedure can be done successfully, with good early post-transplantation outcomes, in carefully selected patients.

FUNDING:

National Institutes of Health. VIDEO ABSTRACT.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Lung Transplantation / Critical Illness / COVID-19 / Lung Type of study: Diagnostic study / Etiology study / Prognostic study Limits: Female / Humans / Male / Middle aged Language: English Journal: Lancet Respir Med Year: 2021 Document Type: Article

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / Lung Transplantation / Critical Illness / COVID-19 / Lung Type of study: Diagnostic study / Etiology study / Prognostic study Limits: Female / Humans / Male / Middle aged Language: English Journal: Lancet Respir Med Year: 2021 Document Type: Article