Journal Article

Lung transplantation as therapeutic option in acute respiratory distress syndrome for coronavirus disease 2019-related pulmonary fibrosis

Huang, Jian-An, Lu, Xiao-Jie, Xu, Xin, Jiang, Shu-Yun, Zhao, Jin, Li, Jia-Shu, Jiao, Guo-Hui, Wang, Da-Peng, Huang, Dong-Xiao, Liu, Feng, Lu, Rong-Guo, Zhang, Xiao-Qin, He, Jian-Xing, Huang, Jian, Zhou, Li, Wu, Bo, Wang, Gui-Long, Jiao, Guo-Qing, Wei, Dong, Qiao, Kun, Ye, Shu-Gao, Chen, Jing-Yu, Hu, Chun-Xiao, Li, Hui-Xing, Yang, Yi

2020

Overview

Critical patients with the coronavirus disease 2019 (COVID-19), even those whose nucleic acid test results had turned negative and those receiving maximal medical support, have been noted to progress to irreversible fatal respiratory failure. Lung transplantation (LT) as the sole therapy for end-stage pulmonary fibrosis related to acute respiratory distress syndrome has been considered as the ultimate rescue therapy for these patients. From February 10 to March 10, 2020, three male patients were urgently assessed and listed for transplantation. After conducting a full ethical review and after obtaining assent from the family of the patients, we performed three LT procedures for COVID-19 patients with illness durations of more than one month and extremely high sequential organ failure assessment scores. Two of the three recipients survived post-LT and started participating in a rehabilitation program. Pearls of the LT team collaboration and perioperative logistics were summarized and continually improved. The pathological results of the explanted lungs were concordant with the critical clinical manifestation, and provided insight towards better understanding of the disease. Government health affair systems, virology detection tools, and modern communication technology all play key roles towards the survival of the patients and their rehabilitation. LT can be performed in end-stage patients with respiratory failure due to COVID-19-related pulmonary fibrosis. If confirmed positive-turned-negative virology status without organ dysfunction that could contraindicate LT, LT provided the final option for these patients to avoid certain death, with proper protection of transplant surgeons and medical staffs. By ensuring instant seamless care for both patients and medical teams, the goal of reducing the mortality rate and salvaging the lives of patients with COVID-19 can be attained.

• Publisher: The Chinese Medical Association, produced by Wolters Kluwer, Inc. under the CC-BY-NC-ND license,Lippincott Williams & Wilkins Ovid Technologies,Wuxi Lung Transplant Center, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, China%Department of Thoracic Surgery, Shenzhen Third People’s Hospital, Shenzhen, Guangdong 518100, China%Department of Thoracic Surgery/Oncology, State Key Laboratory and National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong 510120, China%Department of Cardiothoracic Surgery, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, China%Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu 210009, China%Wuxi Fifth Hospital, Wuxi, Jiangsu 214000, China%Department of Respiratory Medicine and Critical Care Medicine, The First People’s Hospital of Lianyungang City, Lianyungang, Jiangsu 222061, China%Department of Critical Care Medicine, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, China%Department of Anesthesiology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu 214023, China%Department of Respiratory Medicine, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, China,Wolters Kluwer Health,Wolters Kluwer
• Subject: Aged / Betacoronavirus / Blood & organ donations / Coronary vessels / Coronavirus Infections - complications / Coronavirus Infections - mortality / Coronaviruses / COVID-19 / Disease transmission / Extracorporeal Membrane Oxygenation / Heart / Hospitals / Humans / Lung Transplantation - methods / Lung transplants / Male / Medical personnel / Middle Aged / Original / Pandemics / Patients / Pneumonia, Viral - complications / Pneumonia, Viral - mortality / Pulmonary fibrosis / Pulmonary Fibrosis - mortality / Pulmonary Fibrosis - surgery / Rehabilitation / Respiratory distress syndrome / Respiratory Distress Syndrome - mortality / Respiratory Distress Syndrome - surgery / Respiratory failure / SARS-CoV-2