Video Consultation in Lung Transplant Recipients during the COVID-19 Pandemic

BackgroundThe COVID-19 pandemic has disrupted health care systems worldwide. This is due to the demand for medical resources in other areas as well as concern for the risk of nosocomial SARS-CoV-2 exposure. The interruption of routine care is especially problematic for patients with chronic conditions requiring regular follow-up, such as lung transplant recipients. New methods like telemedicine are needed to provide care to these patients. MethodsA retrospective analysis of video consultations (VC) in comparison to on-site visits (OSV) was performed during a six-week period in a lung transplant center in Germany. VC included a structured work-up questionnaire and vital sign documentation. ResultsDuring the 6-week study period, 75 VC were performed for 53 patients and 75 OSV by 51 patients occurred. By the end of our study period, 77% of physician-patient contacts occurred via VC. Overall, physician-patient consultations were reduced by 47% in comparison to an equivalent time frame in 2019. In 62% of cases, VC resulted in a concrete clinical decision. For two VC patients, the indication for inpatient admission was established during the consultation. One COVID-19 patient in home quarantine was admitted due to respiratory failure detected by VC. Patient satisfaction with VC was high. ConclusionsBy transitioning to VC, OSV for lung transplant patients during the COVID-19 pandemic was reduced. VC was well received by the majority of patients. This technology can be adopted to provide care for a wide range of chronic illnesses.

Home spirometry as early detector of azithromycin refractory bronchiolitis obliterans syndrome in lung transplant recipients.

BACKGROUND: To evaluate the utility of home spirometry (HS) versus office spirometry (OS) in assessing treatment response to azithromycin in bronchiolitis obliterans syndrome (BOS). METHODS: 239 Lung transplant recipients were retrospectively studied. ΔFEV1 ± 10% from FEV1 at azithromycin initiation for ≥7 consecutive days in HS or ≥2 measures in OS were taken as cut-off for response or progression. RESULTS: Based upon HS, 161/239 (67%) patients were progressive despite macrolide, 19 of who exhibited transient improvement in FEV1 (11%). Time to progression was 29 (13-96) days earlier with HS than in OS. Forty-six (19%) recipients responded in HS after median 81 (22-343) days, whilst 22% remained stable. Concordance in azithromycin treatment response between OS and HS was observed in 210 of 239 patients (88%). Response or stabilization conferred significant improvement in survival (p = 0.005). Transient azithromycin responders demonstrated improved survival when compared to azithromycin refractory patients (p = 0.034). CONCLUSIONS: HS identified azithromycin refractory patients significantly earlier than OS, possibly facilitating aggressive treatment escalation that may improve long-term outcome. Treatment response to azithromycin should be assessed 4 weeks after initiation. Responders demonstrated best survival, with even transient response conferring benefit. Macrolide-refractory BOS carried the worst prognosis.

Spirometric obstructive lung function pattern early after lung transplantation.

BACKGROUND: An obstructive pattern in pulmonary function test is common after lung transplantation (LTx) and may be caused by multiple disorders. In this study, the impact and outcome of an obstructive spirometric pattern identified in transplant recipients early posttransplantation were investigated. METHODS: Analyzing all patients undergoing double LTx between September 1, 2007, and October 1, 2009, we separated patients with an obstructive (forced expiratory volume in 1 sec [FEV(1)]: vital capacity [VC] <0.7) and a nonobstructive pattern (FEV(1):VC ≥0.7) in pulmonary function tests 3 months after transplantation. Pulmonary function measurement, bronchoscopy, laboratory parameter, computed tomography morphology, mortality, and bronchiolitis obliterans syndrome (BOS)-free survival were analyzed up to 36 months after transplantation. In addition, information about donor lungs were collected (age, smoking history, and blood gas before lung harvesting). RESULTS: From 122 recipients included, 17 (14%) exhibited an obstructive pattern. Recipients with an early obstructive pattern were older at transplantation, had significantly decreased FEV(1), increased total lung capacity, and donor organ with lower pO(2) when ventilated with 100% oxygen before retrieval. Obstructive patients developed their best FEV(1) earlier after LTx and demonstrated a significant increase in BOS development (47% vs. 14%). CONCLUSIONS: An obstructive lung function pattern early after LTx was associated with earlier development of BOS and may have negative impact on outcome after double LTx. Early obstructive pattern after transplantation might be an indication of structural donor lung injury.