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Gok E, Patel M, Stojkovic B, Patel J, Dinh K, Hussein R, Akkanti B, Gregoric I, Jyothula S. Lung Transplantation in COVID 19 ARDS - Short Term Outcomes. J Heart Lung Transplant 2021. [PMCID: PMC7979378 DOI: 10.1016/j.healun.2021.01.2035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction COVID-19 associated severe acute respiratory syndrome rapidly progress to irreversible lung injury, multiple organ failure and death. Lung transplantation is considered as the rescue therapy for these patients. Herein, we reported a case series of two successful life-saving bilateral lung transplantations for COVID-19-associated respiratory failure. Case Report Case 1: A 69-year-old male was admitted for hypoxia and altered mental status. He was diagnosed with COVID-19 pneumonia by abnormal CT findings and positive PCR result. After receiving a course of dexamethasone, convalescent plasma, remdesivir and broad-spectrum antibiotics, he remained to be profoundly hypoxic, requiring non-invasive ventilation. Following two negative PCR results, he underwent bilateral lung transplantation on day 57. He was discharged to rehab unit on postoperative day 26. No desaturation was observed with the 6-min walk test on 30-day follow-up. Case 2: A 63-year-old male was presented with cough, and dyspnea. He was hemodynamically stable, SpO2 was 94%, chest x-ray was normal and tested positive for COVID-19. He was discharged home with dexamethasone and bronchodilators. However, he presented back on day 6 with worsening dyspnea. He was admitted and received a course of dexamethasone, remdesivir, convalescent plasma and broad-spectrum antibiotics. Due to persistent hypoxic respiratory failure, the patient underwent bilateral orthotopic lung transplantation on day 68. His postoperative course was complicated by primary graft dysfunction stage 3 and required open tracheostomy. His condition gradually improved and decannulated. He is currently on room air and able to walk 30 ft using a roller walker. Summary SARS-CoV-2 recovery is characterized by post inflammatory fibrosis and multi organ dysfunction. Lung transplantation can be successfully performed in patients with final stage respiratory failure of COVID-19 related pulmonary fibrosis.
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Lingappan K, Karmouty-Quintana H, Davies J, Akkanti B, Harting MT. Understanding the age divide in COVID-19: why are children overwhelmingly spared? Am J Physiol Lung Cell Mol Physiol 2020; 319:L39-L44. [PMID: 32491949 PMCID: PMC7324935 DOI: 10.1152/ajplung.00183.2020] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/19/2020] [Accepted: 05/19/2020] [Indexed: 12/13/2022] Open
Abstract
The rapid emergence and subsequent global dissemination of SARS-CoV-2 disease (COVID-19) has resulted in over 4 million cases worldwide. The disease has a marked predilection for adults, and children are relatively spared. Understanding the age-based differences in pathophysiological pathways and processes relevant to the onset and progression of disease both in the clinical course and in experimental disease models may hold the key to the identification of therapeutic targets. The differences in the clinical course are highlighted by the lack of progression of the SARS-CoV-2 infection beyond mild symptoms in a majority of children, whereas in adults the disease progresses to acute lung injury and an acute respiratory distress syndrome (ARDS)-like phenotype with high mortality. The pathophysiological mechanisms leading to decreased lung injury in children may involve the decreased expression of the mediators necessary for viral entry into the respiratory epithelium and differences in the immune system responses in children. Specifically, decreased expression of proteins, including angiotensin-converting enzyme 2 (ACE2) and Transmembrane Serine Protease 2 (TMPRSS2) in the airway epithelium in children may prevent viral entry. The immune system differences may include a relative preponderance of CD4+ T cells, decreased neutrophil infiltration, decreased production of proinflammatory cytokines, and increased production of immunomodulatory cytokines in children compared with adults. Notably, the developing lung in children may have a greater capacity to recover and repair after viral infection. Understanding the relative contributions of the above processes to the protective phenotype in the developing lung can guide the trial of the appropriate therapies in adults.
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Affiliation(s)
- K. Lingappan
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - H. Karmouty-Quintana
- Department of Biochemistry and Molecular Biology, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - J. Davies
- Division of Neonatology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - B. Akkanti
- Divisions of Pulmonary, Critical Care, Sleep Medicine, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
| | - M. T. Harting
- Department of Pediatric Surgery, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas
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Jafri S, Hussain R, Akkanti B, Williams J, Labdi B, Osta H. PS02.01 Use of β-blockers and Risk of Developing Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Quintana-Quezada RA, Rajapreyar I, Postalian-Yrausquin A, Yeh YC, Choi S, Akkanti B, Sieg A, Weeks P, Patel M, Patel J, Nathan S, Kar B, Loyalka P, Gregoric I. Clinical Factors Implicated in Primary Graft Dysfunction After Heart Transplantation: A Single-center Experience. Transplant Proc 2017; 48:2168-71. [PMID: 27569965 DOI: 10.1016/j.transproceed.2016.02.073] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/16/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND Primary graft dysfunction (PGD) is a frequent complication after cardiac transplantation and remains one of the leading causes of mortality in these patients. The objective of this case-control study is to identify donor and surgical procedure's factors associated with PGD, and further guide possible strategies to prevent PGD. METHODS Retrospective analysis of the medical records of patients who underwent cardiac transplantation at Memorial Hermann Hospital at Texas Medical Center between October 2012 and February 2015. RESULTS The study population included 99 patients, of which 18 developed PGD. Univariate analysis of donor characteristics revealed opioid use (P = .049) and death owing to anoxia (P = .021) were associated with PGD. The recipient/donor blood type match AB/A was significantly associated with PGD (P = .031). Time from brain death to aortic cross clamp (TBDACC) of ≥3 and ≥5 days were also found to be associated with PGD (P = .0011 and .0003, respectively). Multivariate analysis confirmed that patients with a time from brain death to aortic cross clamp ≥3 and ≥5 days had lesser odds of developing PGD (odds ratio, 0.098 [P = .0026] and OR, 0.092 [P = .0017], respectively]. CONCLUSIONS Our study showed that a longer time from brain death to aortic cross clamp was associated with lower odds of developing PGD. Therefore, postponing heart procurement for a few days after brain death seems to be beneficial in preventing PGD.
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Affiliation(s)
- R A Quintana-Quezada
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas.
| | - I Rajapreyar
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - A Postalian-Yrausquin
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - Y C Yeh
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - S Choi
- Division of Clinical and Translational Sciences, Department of Internal Medicine, University of Texas Medical School at Houston, Houston, Texas
| | - B Akkanti
- Division of Critical Care, Pulmonary and Sleep, University of Texas Medical School at Houston, Houston, Texas
| | - A Sieg
- Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, Texas
| | - P Weeks
- Department of Pharmacy, Memorial Hermann - Texas Medical Center, Houston, Texas
| | - M Patel
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - J Patel
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - S Nathan
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - B Kar
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - P Loyalka
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
| | - I Gregoric
- Center for Advanced Heart Failure, University of Texas Health Science Center at Houston/Memorial Hermann Hospital, Texas Medical Center, Houston, Texas
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Akkanti B, Kolodziejski P, Rizvi Z, Kesavan R, Parulekar A, Loebe M, La Francesca S, Scheinin S, Nguyen J, Bruckner B, Noon G, Seethamraju H. 356 H1N1 Influenza in Lung Transplant Patients: A Follow Up after One Year. J Heart Lung Transplant 2011. [DOI: 10.1016/j.healun.2011.01.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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