美国首例因严重COVID-19感染导致肺纤维化的肺移植成功

来源：淋床医学   翻译：浪花一朵朵

First Successful Lung Transplantation for Pulmonary Fibrosis Due to Severe COVID-19 Infection in the US

美国首例因严重COVID-19感染导致肺纤维化的肺移植成功

C. Kurihara, and A. Bharat. Northwestern University Feinberg School of Medicine, Chicago, IL.

Introduction: 

Lung transplantation can potentially be a life-saving treatment for patients with non-resolving COVID-19 acute respiratory distress syndrome. Concerns limiting transplant include recurrence of SARS-CoV-2 infection in the allograft, technical challenges imposed by viralmediated injury to the native lung. Here, we report the first successful lung transplantation in a patient with non-resolving COVID-19 associated acute respiratory distress syndrome in the United States.

导言：

肺移植可能是一种挽救未解决的COVID-19急性呼吸窘迫综合征患者生命的治疗方法。限制移植的问题包括:同种异体移植中SARS-CoV-2感染的复发，病毒介导的天然肺损伤带来的技术挑战。在这里，我们报道了美国首例未解决的COVID-19相关急性呼吸窘迫综合征患者的肺移植成功。

Case Report: 

The recipient was a 28-year old female with past medical history of neuromyelitis optica treated with mycophenolate and rituximab who developed COVID pneumonia leading acute respiratory distress syndrome. The patient was intubated for 8 days with prone prior to initiation of VV ECMO. Her ECMO course was complicated by right sided pneumothorax requiring multiple pleural tubes and the development of Serratia marcescens pneumonia with left lower lung necrosis, and a liver capsular bleed necessitating emergent exploratory laparotomy. 

病例报告：

接受者为一名28 岁女性，既往有视神经脊髓炎病史，曾接受麦考酚酯和利妥昔单抗治疗，并发COVID 肺炎导致急性呼吸窘迫综合征。患者在 VV ECMO 开始前俯卧插管 8 天。她的体外膜肺氧合（ ECMO ）过程并发右侧气胸，需要多个胸膜管，并发粘质沙雷氏菌肺炎的发展与左下肺坏死，肝包膜出血需要紧急剖腹探查。

(Figure1a, b)

She received antibiotics, remdesivir, hydroxychloroquine, tocilizumab, and convalescent plasma. However there was no signs of recovery and she was listed for lung transplantation after ECMO support for 32 days . Implantation was supported with central VA ECMO, and there was severe dense vascular adhesions bilaterally with severe distortion of hilar. 

(图 1a 和 b )她接受了抗生素、瑞德西韦、羟氯喹、托珠单抗和恢复期血浆治疗。但是，没有任何恢复的迹象，在体外膜肺氧合支持 32 天后，她被列入肺移植名单。植入用中央 VA ECMO 支架，两侧致密血管粘连严重，肺门严重扭曲。

(Figure1c) 

Explanted Lungs damaged by COVID-19 were free of virus but pathology showed extensive evidence of acute interstitial inflammation with fibrosis which consistence with end-stage pulmonary fibrosis. 

COVID-19 损伤的肺组织无病毒感染，但病理学检查显示广泛的肺间质急性炎症伴纤维化，符合终末期肺纤维化。

(Figure1d, e) 

The patient was decannulated from VV ECMO on POD 17, and was discharged on POD 27. 

患者在体外膜肺氧合(VV ECMO) 17日拔管，并于术后 27 天出院。

(Figure1f) 

Four months after transplantation, she is at home with oxygen saturations above 98% on room air.

移植后 4 个月，她在家中室内空气氧饱和度超过 98 %。

Summary: 

Our experience suggest that lung transplant is the only option for survival for some patients with severe COVID-19 develop fibrotic lung.

总结：

我们的经验表明，对于一些严重COVID-19发展为肺纤维化的患者来说，肺移植是生存的唯一选择。

参考文献：

Kurihara C. and Bharat A.. First Successful Lung Transplantation for Pulmonary Fibrosis Due to Severe COVID-19 Infection in the US[J]. Journal of Heart and Lung Transplantation, 2021, 40(4S) : S499-S500.