Post–Lung Transplantation Outcomes and Ex Vivo Histopathological Findings in Severe Post-Covid-19 Pulmonary Disease—A Single-Center Experience. (17th August 2022)

• Record Type: Journal Article
• Authors: Javaid, Hana; Nigo, Masayuki; Zhao, Bihong; Trujillo, Daniel Ocazionez; Hasbun, Rodrigo; Ostrosky-Zeichner, Luis; Patel, Manish; Jyothula, Soma
• Is Part Of: Open forum infectious diseases. Volume 9:Number 9(2022)
• Publication Date: 2022-08-17
• Subjects: COVID-19 -- ARDS -- hospitalization -- lung transplantation -- outcomes; Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofac425
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: A significant proportion of patients with severe and persistent coronavirus disease 2019 (COVID-19) require continuous ventilatory support and occasional extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome (ARDS). Lung transplantation is a treatment option for patients who develop severe ARDS. Methods: Our lung transplant database was retrospectively reviewed for patients who underwent lung transplantation for COVID-19 pulmonary disease at Memorial Hermann Hospital, Texas Medical Center, Houston, Texas, from January 2020 to March 2022. We evaluated outcomes of patients who were followed in our clinic at least 6 months post-transplant. Pretransplant patient characteristics, COVID-19-related treatment, histopathology results, and postdischarge course were evaluated. Results: Among a total of 13 lung transplant recipients, 6 consecutive patients were identified who had a minimum of 6 months of follow-up post–lung transplantation. The average age of patients was 55 years, with a male predominance. The median time to transplantation was 111 days. All 6 patients had significant postinfectious complications due to COVID-19 before transplant. Histopathological findings from explanted lungs showed a predominance of fibrotic change. There were no reported cases of rejection or graft dysfunction. 5 patients had minimal to no post-transplant infectious complications. One patient died 218 days post-transplant from infectious complications. Conclusions: Five out of six lung transplant recipients at our institution have demonstrated excellent long-term outcomes after index hospitalization, for a mean follow-up of 13 months post–lung transplantation. Lung transplantation for lung fibrosis due to COVID-19 is an acceptable salvage treatment option. Larger studies are warranted to confirm these findings. Abstract : Lung transplantation for lung fibrosis due to COVID-19 can be considered a safe salvage treatment option with relatively low infectious post-transplant complications despite significant infectious complications before lung transplantation. Larger studies are warranted to confirm the findings.