Lung transplantation in the COVID-19 Era: A multi-faceted challenge

Messika, Jonathan; Roux, Antoine; Dauriat, Gaëlle; Pavec, Jérôme Le

doi:10.1016/j.resmer.2021.100866

Cited by 4 publications

(2 citation statements)

References 35 publications

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“…BOLT provides a valuable last resort therapeutic option to PA-COVID patients that suffer from severe respiratory insufficiency secondary to diffuse lung disease and cannot be removed from ECMO therapy, although there are still concerns regarding possible recurrence of viral pneumonia in the allograft, severe deconditioning associated with lengthy illness prior to a long surgery that might complicate the recovery, and the uncertainty of the outcome of the spontaneous repair after severe COVID [ [45] , [46] , [47] , [48] ]. To our knowledge, there are still evidence-based guidelines to support the selection of patients that should be considered for lung transplant.…”

Section: Discussionmentioning

confidence: 99%

Nonspecific interstitial pneumonia pattern is a frequent finding in patients with post-acute COVID-19 syndrome treated with bilateral orthotopic lung transplantation: current best evidence

2023

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Section: Discussionmentioning

confidence: 99%

Nonspecific interstitial pneumonia pattern is a frequent finding in patients with post-acute COVID-19 syndrome treated with bilateral orthotopic lung transplantation: current best evidence

2023

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“…As of March 16, 2023, globally there are 760,360,956 confirmed cases of COVID-19 with 6,873,477 deaths (0.9%) [6]. Efforts were made to maintain lung transplant activity irrespective of the increased COVID-19 rates [7]. Knowing the higher unaccounted risk factors that are not computed into the mortality model for the lung allocation score, herein we aimed to assess the risk of readmissions based on group classifications to better understand specific groups that are at risk for various readmissions and their frequency of readmission during a period when hospital resources were strained due to the SARS-COV-2 pandemic.…”

Section: Introductionmentioning

confidence: 99%

Frequency of Unplanned Readmissions Following Lung Transplantation During the SAR-COV-2 Pandemic When Hospital Resources Were Strained

Cole,

Golts,

Bernales

et al. 2024

OBM Transplant

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Despite the concerted efforts by lung transplant recipients (LTR) and their medical teams, hospital readmissions are common in the first year following transplantation. Reasons for unplanned readmissions include allograft rejection, infections, and respiratory failure before the SARS-COV-2 pandemic. Clinical predictors of readmissions have changed over time with the higher risk factors of acceptable criteria for recipients and donors. We aimed to assess more recent readmission rates based on group classifications to better understand specific groups that are at risk for various readmissions during the SARS-COV-2 pandemic when hospital resources were strained. A retrospective analysis for LTR at UCSD was performed from 1/1/2018 to 6/30/2022. We recorded the baseline demographics; LAS at the time of lung transplant; mechanical ventilation prior to lung transplant; the need for VV-or VA-ECMO prior to or after lung transplantation; categories for UNOS listing (groups A, B, C, D); PGD grade 3 based on the ISHLT definition; and acquisition of serious donor-derived infections. We recorded the primary reason for all the readmissions and the duration of admission. Descriptive statistics were used for the analysis of this 4.5-year patient cohort. 149 LT were performed. 29 were single LTR while 120 were bilateral LTR. Median age of 57 years, 63 patients (42%) were female. Indications for transplantation included 28 (19%) group A, 19 (13%) group B, 12 (8%) group C, and 90 (60%) group D. The median length of follow-up following lung transplant was 1.7 years. Collectively, there were 73 patients (49%) that required readmissions. On average, there are 2.5 readmissions per patient for our cohort. Most common reasons for unplanned readmission included infections, transplant-related (transplant rejection, other complications of transplant, etc.), and GI Related. This was primarily seen in the group D cohort. The median hospital LOS at readmission was 3.8 days (4 hours to 34.6 days). Despite infection being the leading cause of readmission, only 11 cases were related to COVID-19 infection. No death occurred with a readmission. Groups B and D appear to be at a higher risk for readmission, irrespective of the pre-LT LAS and need for mech vent or VV-ECMO.

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CT imaging findings in lung transplant recipients with COVID-19

et al. 2022

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Objectives Our goal was to compare the chest computed tomography (CT) imaging findings of COVID-19 in lung transplant recipients (LTR) and a group of non-transplanted controls (NTC). Methods This retrospective study included 51 consecutive LTR hospitalized with COVID-19 from two centers. A total of 75 NTC were included for comparison. Images were classified regarding the standardized RSNA category, main pattern of lung attenuation, and longitudinal and axial distribution. Quantitative CT (QCT) analysis was performed to evaluate percentage of high attenuation areas (%HAA, threshold −250 to −700 HU). CT scoring was used to measure severity of parenchymal abnormalities. Results The imaging findings of COVID-19 in LTR were significantly different from controls regarding the RSNA classification and pattern of lung attenuation. LTR had a significantly higher proportion of patients with an indeterminate pattern on CT (0.31 vs. 0.11, p = 0.014). The most frequent pattern of attenuation in LTR was predominantly consolidation (0.39 vs. 0.22, p = 0.144) followed by a mixed pattern of ground-glass opacities (GGO) and consolidation (0.37 vs. 0.20, adjusted p = 0.102). On the other hand, the most common pattern in NTC was GGO predominant (0.58 vs. 0.24 of LTR, p = 0.001). LTR had significantly more severe parenchymal disease measured by CT score and %HAA by QCT (0.372 ± 0.08 vs. 0.148 ± 0.06, p < 0.001). Conclusion The most frequent finding of COVID-19 in LTR is a predominant pattern of consolidation. Compared to NTC, LTR more frequently demonstrated an indeterminate pattern according to the RSNA classification and more extensive lung abnormalities on QCT and semi-quantitative scoring. Key Points • The most common CT finding of COVID-19 in LTR is a predominant pattern of consolidation followed by a mixed pattern of GGO and consolidation, while controls more often have a predominant pattern of GGO . • LTR more often presents with an indeterminate pattern of COVID-19 by RSNA classification than controls; therefore, molecular testing for COVID-19 is essential for LTR presenting with lower airway infection independently of imaging findings . • LTR had more extensive disease by semi-quantitative CT score and increased percentage areas of high attenuation on QCT .

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Lung transplantation in the COVID-19 Era: A multi-faceted challenge

Cited by 4 publications

References 35 publications

Nonspecific interstitial pneumonia pattern is a frequent finding in patients with post-acute COVID-19 syndrome treated with bilateral orthotopic lung transplantation: current best evidence

Nonspecific interstitial pneumonia pattern is a frequent finding in patients with post-acute COVID-19 syndrome treated with bilateral orthotopic lung transplantation: current best evidence

Frequency of Unplanned Readmissions Following Lung Transplantation During the SAR-COV-2 Pandemic When Hospital Resources Were Strained

CT imaging findings in lung transplant recipients with COVID-19

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