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Wein AN, Liu J, Lin CY. Evolution of pathological findings in surveillance biopsies of lung transplant recipients infected with SARS-CoV-2. Transpl Infect Dis 2022; 24:e13823. [PMID: 35279033 PMCID: PMC9115334 DOI: 10.1111/tid.13823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/17/2022] [Accepted: 02/21/2022] [Indexed: 11/28/2022]
Abstract
Background Previous reports of coronavirus disease 2019 (COVID‐19) following lung transplantation generally described a grim prognosis, but these were anecdotal case series of symptomatic patients. A systematic study of the outcomes and pathology of SARS‐CoV‐2 infection in a large cohort of lung transplant patients is lacking. Methods To determine the histopathologic evolution of COVID‐19 in lung transplant recipients, we identified all patients who underwent surveillance transbronchial biopsies at our institution, tested positive for SARS‐CoV‐2, and had multiple pathology specimens available for evaluation. Histology was reviewed and immunofluorescence for SARS‐CoV‐2 nucleocapsid protein was performed. Results Ten patients met inclusion criteria. Half (5/10) had incidental diagnosis on routine respiratory pathogen testing at the time of transbronchial biopsy. Six patients were hospitalized, with three requiring intensive care unit (ICU) admission. One patient died. Two specimens showed new onset International Society for Heart and Lung Transplantation (ISHLT) Grade A2 rejection at or following diagnosis. One patient developed bronchiolitis obliterans 111 days following diagnosis and 1 year post transplant. Two patients had organizing pneumonia at diagnosis and three patients showed evolving lung injury following diagnosis. The SARS‐CoV‐2 nucleocapsid protein was detected in a subset of samples at diagnosis and up to 111 days following diagnosis. Conclusions Overall, the pathology of SARS‐CoV‐2 infection in lung transplant patients is varied, ranging from no pathologic alterations to organizing pneumonia and lung injury. The pathology findings did not necessarily correlate with clinical acuity, as one patient admitted to the ICU had normal pathology. These findings may be generalizable to non‐transplant patients and require more follow‐up regarding long‐term outcomes.
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Affiliation(s)
- Alexander N Wein
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
| | - Jing Liu
- Cardiovascular Division, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Chieh-Yu Lin
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO
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Beyoglu MA, Sahin MF, Turkkan S, Basaran FC, Yazicioglu A, Bektas SG, Tekce YT, Yekeler E. Vaccine Breakthrough Severe COVID-19 in a Lung Recipient. Transplant Proc 2021; 54:1569-1571. [PMID: 34887098 PMCID: PMC8585586 DOI: 10.1016/j.transproceed.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 11/26/2022]
Abstract
The vaccines developed against severe acute respiratory syndrome coronavirus 2 are seen as the most crucial weapon in controlling the epidemic. It has been reported in early-stage vaccine studies that vaccines provide up to 95% protection against severe disease and mortality, even in the absence of symptomatic infection. Reports on vaccine breakthrough infections that developed after widespread vaccination are available in the literature. In addition to the general population, the course of vaccine breakthrough infections in immunocompromised patients is a matter of concern. This case report aimed to define severe coronavirus disease 2019 developing in a lung recipient who received 3 doses of inactivated virus vaccine.
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Affiliation(s)
- Muhammet Ali Beyoglu
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey.
| | - Mehmet Furkan Sahin
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Sinan Turkkan
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Fatmanur Celik Basaran
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Alkin Yazicioglu
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Serife Gokbulut Bektas
- Department of Intensive Care Unit, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Yasemin Tezer Tekce
- Clinic of Infectious Disease, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Erdal Yekeler
- Department of General Thoracic Surgery and Lung Transplantation, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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Mahan LD, Lill I, Halverson Q, Mohanka MR, Lawrence A, Joerns J, Bollineni S, Kaza V, La Hoz RM, Zhang S, Kershaw CD, Terada LS, Torres F, Banga A. Post-infection pulmonary sequelae after COVID-19 among patients with lung transplantation. Transpl Infect Dis 2021; 23:e13739. [PMID: 34605596 PMCID: PMC8646912 DOI: 10.1111/tid.13739] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 09/12/2021] [Accepted: 09/15/2021] [Indexed: 12/22/2022]
Abstract
BACKGROUND There is limited data on outcomes among lung transplant (LT) patients who survive Coronavirus disease 2019 (COVID-19). METHODS Any single or bilateral LT patients who tested positive for SARS-CoV-2 between March 1, 2020, to February 15, 2021 (n = 54) and survived the acute illness were included (final n = 44). Each patient completed at least 3 months of follow-up (median: 4.5; range 3-12 months) after their index hospitalization for COVID-19. The primary endpoint was a significant loss of lung functions (defined as > 10% decline in forced vital capacity (FVC) or forced expiratory volume in 1 s (FEV1 ) on two spirometries, at least 3 weeks apart compared to the pre-infection baseline). RESULTS A majority of the COVID-19 survivors had persistent parenchymal opacities (n = 29, 65.9%) on post-infection CT chest. Patients had significantly impaired functional status, with the majority reporting residual disabilities (Karnofsky performance scale score of 70% or worse; n = 32, 72.7%). A significant loss of lung function was observed among 18 patients (40.9%). Three patients met the criteria for new chronic lung allograft dysfunction (CLAD) following COVID-19 (5.6%), with all three demonstrating restrictive allograft syndrome phenotype. An absolute lymphocyte count < 0.6 × 103 /dl and ferritin > 150 ng/ml at the time of hospital discharge was independently associated with significant lung function loss. CONCLUSIONS A significant proportion of COVID-19 survivors suffer persistent allograft injury. Low absolute lymphocyte counts (ALC) and elevated ferritin levels at the conclusion of the hospital course may provide useful prognostic information and form the basis of a customized strategy for ongoing monitoring and management of allograft dysfunction. TWEET Twitter handle: @AmitBangaMD Lung transplant patients who survive COVID-19 suffer significant morbidity with persistent pulmonary opacities, loss of lung functions, and functional deficits. Residual elevation of the inflammatory markers is predictive.
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Affiliation(s)
- Luke D Mahan
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Isaac Lill
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Quinn Halverson
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Manish R Mohanka
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Adrian Lawrence
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - John Joerns
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Srinivas Bollineni
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Vaidehi Kaza
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Ricardo M La Hoz
- Infectious Disease and Geographic Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Song Zhang
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Corey D Kershaw
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Lance S Terada
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Fernando Torres
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
| | - Amit Banga
- Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, University of Texas System, Dallas, Texas, USA
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