tetano
Editor, Senior Moderator
Transplantation
. 2022 Nov 21.
doi: 10.1097/TP.0000000000004428. Online ahead of print.
Lung Transplantation for COVID-19 Pulmonary Sequelae
Hiromu Kehara[SUP] 1 [/SUP], Chirantan Mangukia[SUP] 1 [/SUP], Gengo Sunagawa[SUP] 1 [/SUP], Sebastian A Iturra[SUP] 1 [/SUP], Roh Yanagida[SUP] 1 [/SUP], Mohammed Kashem[SUP] 1 [/SUP], Yuri Persidsky[SUP] 2 [/SUP], Kartik Shenoy[SUP] 3 [/SUP], Albert J Mamary[SUP] 3 [/SUP], Nathaniel Marchetti[SUP] 3 [/SUP], Francis Cordova[SUP] 3 [/SUP], Gerard J Criner[SUP] 3 [/SUP], Yoshiya Toyoda[SUP] 1 [/SUP], Norihisa Shigemura[SUP] 1 3 [/SUP]
Affiliations
Abstract
Background: The role of lung transplantation for coronavirus disease 2019 (COVID-19)-related lung failure is evolving as the pandemic persists.
Methods: From January 2021 to April 2022, 20 patients (median age 62 y; range 31-77) underwent lung transplantation for COVID-related lung failure at our institution. We reviewed their clinical and intraoperative characteristics and early outcomes including postoperative complications.
Results: Eleven patients (55%) had chronic lung disease when they contracted COVID-19. All 20 patients required hospitalization for antivirus treatment. Median lung allocation score was 74.7 (33.1-94.0). Thirteen patients (65%) underwent single-lung transplants, and 7 patients (35%) underwent double-lung transplants. Concomitant coronary artery bypass graft surgery was performed in 2 (10%) patients because of severe coronary artery disease. Postoperatively, venovenous extracorporeal membrane oxygenation was needed in 3 patients (15%) because of severe primary graft dysfunction; all were eventually weaned. Ten patients (50%) experienced deep venous thrombosis, and 1 eventually developed a major pulmonary embolus. The median intensive care unit stay and hospital stays were 6.5 d (3-44) and 18 d (7-77), respectively. During a median follow-up of 201 d (47-418), we experienced 1 late mortality due to COVID-19-related myocarditis. Among the 13 patients with single-lung transplant, 5 demonstrated improvement in their native lungs.
Conclusions: Lung transplantation yielded favorable early outcomes in a heterogeneous patient cohort that included older patients, obese patients, and patients with coronary artery disease or preexisting chronic lung disease. Our data also shed light on the transforming role of lung transplantation for the pulmonary sequelae of a complex multisystem COVID-19 disorder.
. 2022 Nov 21.
doi: 10.1097/TP.0000000000004428. Online ahead of print.
Lung Transplantation for COVID-19 Pulmonary Sequelae
Hiromu Kehara[SUP] 1 [/SUP], Chirantan Mangukia[SUP] 1 [/SUP], Gengo Sunagawa[SUP] 1 [/SUP], Sebastian A Iturra[SUP] 1 [/SUP], Roh Yanagida[SUP] 1 [/SUP], Mohammed Kashem[SUP] 1 [/SUP], Yuri Persidsky[SUP] 2 [/SUP], Kartik Shenoy[SUP] 3 [/SUP], Albert J Mamary[SUP] 3 [/SUP], Nathaniel Marchetti[SUP] 3 [/SUP], Francis Cordova[SUP] 3 [/SUP], Gerard J Criner[SUP] 3 [/SUP], Yoshiya Toyoda[SUP] 1 [/SUP], Norihisa Shigemura[SUP] 1 3 [/SUP]
Affiliations
- PMID: 36525557
- DOI: 10.1097/TP.0000000000004428
Abstract
Background: The role of lung transplantation for coronavirus disease 2019 (COVID-19)-related lung failure is evolving as the pandemic persists.
Methods: From January 2021 to April 2022, 20 patients (median age 62 y; range 31-77) underwent lung transplantation for COVID-related lung failure at our institution. We reviewed their clinical and intraoperative characteristics and early outcomes including postoperative complications.
Results: Eleven patients (55%) had chronic lung disease when they contracted COVID-19. All 20 patients required hospitalization for antivirus treatment. Median lung allocation score was 74.7 (33.1-94.0). Thirteen patients (65%) underwent single-lung transplants, and 7 patients (35%) underwent double-lung transplants. Concomitant coronary artery bypass graft surgery was performed in 2 (10%) patients because of severe coronary artery disease. Postoperatively, venovenous extracorporeal membrane oxygenation was needed in 3 patients (15%) because of severe primary graft dysfunction; all were eventually weaned. Ten patients (50%) experienced deep venous thrombosis, and 1 eventually developed a major pulmonary embolus. The median intensive care unit stay and hospital stays were 6.5 d (3-44) and 18 d (7-77), respectively. During a median follow-up of 201 d (47-418), we experienced 1 late mortality due to COVID-19-related myocarditis. Among the 13 patients with single-lung transplant, 5 demonstrated improvement in their native lungs.
Conclusions: Lung transplantation yielded favorable early outcomes in a heterogeneous patient cohort that included older patients, obese patients, and patients with coronary artery disease or preexisting chronic lung disease. Our data also shed light on the transforming role of lung transplantation for the pulmonary sequelae of a complex multisystem COVID-19 disorder.