Lung transplantation for patients with severe COVID-19.
Sci Transl Med
; 12(574)2020 12 16.
Artículo
en Inglés
| MEDLINE | ID: covidwho-1207479
ABSTRACT
Lung transplantation can potentially be a life-saving treatment for patients with nonresolving COVID-19-associated respiratory failure. Concerns limiting lung transplantation include recurrence of SARS-CoV-2 infection in the allograft, technical challenges imposed by viral-mediated injury to the native lung, and the potential risk for allograft infection by pathogens causing ventilator-associated pneumonia in the native lung. Additionally, the native lung might recover, resulting in long-term outcomes preferable to those of transplant. Here, we report the results of lung transplantation in three patients with nonresolving COVID-19-associated respiratory failure. We performed single-molecule fluorescence in situ hybridization (smFISH) to detect both positive and negative strands of SARS-CoV-2 RNA in explanted lung tissue from the three patients and in additional control lung tissue samples. We conducted extracellular matrix imaging and single-cell RNA sequencing on explanted lung tissue from the three patients who underwent transplantation and on warm postmortem lung biopsies from two patients who had died from COVID-19-associated pneumonia. Lungs from these five patients with prolonged COVID-19 disease were free of SARS-CoV-2 as detected by smFISH, but pathology showed extensive evidence of injury and fibrosis that resembled end-stage pulmonary fibrosis. Using machine learning, we compared single-cell RNA sequencing data from the lungs of patients with late-stage COVID-19 to that from the lungs of patients with pulmonary fibrosis and identified similarities in gene expression across cell lineages. Our findings suggest that some patients with severe COVID-19 develop fibrotic lung disease for which lung transplantation is their only option for survival.
Texto completo:
Disponible
Colección:
Bases de datos internacionales
Base de datos:
MEDLINE
Asunto principal:
Fibrosis Pulmonar
/
Trasplante de Pulmón
/
COVID-19
/
Pulmón
Tipo de estudio:
Reporte de caso
/
Estudios diagnósticos
/
Estudio observacional
/
Estudio pronóstico
Tópicos:
Covid persistente
Límite:
Adulto
/
Femenino
/
Humanos
/
Masculino
/
Middle aged
Idioma:
Inglés
Asunto de la revista:
Ciencia
/
Medicina
Año:
2020
Tipo del documento:
Artículo
País de afiliación:
Scitranslmed.abe4282
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