对 COVID-19 患者肺移植结果的多中心国际分析。

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-09-24 DOI:10.1111/ctr.15462

Mohammed Abul Kashem, Gabriel Loor, Amir Emtiazjoo, Matthew Hartwig, Dirk Van Raemdonck, Hannah Calvelli, Andres Leon Pena, Marcelo Salan-Gomez, Huaqing Zhao, Michael Warnick, Mauricio Villavicencio, Fabio Ius, Kamrouz Ghadimi, Jawad Salman, Satish Chandrashekaran, Tiago Machuca, Pablo G. Sanchez, Kathirvel Subramaniam, Arne Neyrinck, Stephen Huddleston, Laurens Ceulemans, Asishana Osho, Ethan D'Silva, Uma Ramamurthy, Andrew Shaffer, Nathaniel Langer, Yoshiya Toyoda

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引用次数: 0

摘要

简介肺移植在COVID-19患者中的应用越来越广泛。虽然已发表了几项关于因冠状病毒病 2019（COVID-19）而导致终末期肺病（ESLD）的肺移植（LT）的单中心和 UNOS 数据库研究，但仍缺乏多中心和国际数据：这是一项来自美国和欧洲 11 个大容量肺移植中心的多中心分析。数据通过多机构 ECLS 注册中心收集，并按 COVID-19 引起的 ESLD 与其他病因进行分层。人口统计学和临床变量采用卡方检验（Chi-square test）和费雪精确检验（Fisher's exact test）进行比较。通过卡普兰-梅耶曲线评估生存率，并通过倾向得分匹配的对数秩检验进行比较：结果：在1606例肺移植受者中，46例（2.9%）因ESLD接受了COVID-19移植，而1560例（97.1%）无COVID-19病史。在COVID-19患者中，30人（65.2%）患有COVID-19相关的ARDS，16人（34.8%）患有COVID-19后纤维化。COVID-19患者的肺分配评分更高（78.0 vs. 44.4，p 结论：COVID-19患者的肺分配评分高于COVID-19患者：因 COVID-19 而接受肺移植的患者的短期生存率与无 COVID-19 的患者相当。我们的研究结果支持这样一种观点，即对于因 COVID-19 而导致 ESLD 的特定患者，应考虑进行肺移植。

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A Multi-Center International Analysis of Lung Transplantation Outcomes in Patients With COVID-19

Introduction

Lung transplantation has become increasingly utilized in patients with COVID-19. While several single-center and UNOS database studies have been published on lung transplants (LTs) for end-stage lung disease (ESLD) from Coronavirus disease 2019 (COVID-19), there is a lack of multi-center and international data.

Methods

This is a multicenter analysis from 11 high-volume lung transplant centers in the United States and Europe. Data were collected through the Multi-Institutional ECLS Registry and stratified by ESLD due to COVID-19 versus other etiologies. Demographics and clinical variables were compared using Chi-square test and Fisher's exact test. Survival was assessed by Kaplan-Meier curves and compared by log-rank test with propensity score matching.

Results

Of 1606 lung transplant recipients, 46 (2.9%) were transplanted for ESLD from COVID-19 compared to 1560 (97.1%) without a history of COVID-19. Among COVID-19 patients, 30 (65.2%) had COVID-19-associated ARDS and 16 (34.8%) had post-COVID-19 fibrosis. COVID-19 patients had higher lung allocation scores (78.0 vs. 44.4, p < 0.0001), had severely limited functional status (37.0% vs. 2.9%, p < 0.0001), had higher preoperative ECMO usage (65.2% vs. 5.4%, p < 0.0001), and spent less time on the waitlist (32 vs. 137 days, p < 0.0001). A 30-day survival was comparable between COVID-19 and non-COVID-19 patients before (100% vs. 98.7%, p = 0.39) and after propensity matching (p = 0.15).

Conclusions

Patients who received LTs due to COVID-19 had short-term survival comparable to that of patients without COVID-19. Our findings support the idea that lung transplantation should be considered for select patients with ESLD due to COVID-19.

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.