Lung transplantation for acute COVID-19: the Toronto Lung Transplant Program experience.

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Date: Sept. 27, 2021
From: CMAJ: Canadian Medical Association Journal(Vol. 193, Issue 38)
Publisher: CMA Joule Inc.
Document Type: Clinical report
Length: 2,567 words
Lexile Measure: 1630L

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Case 1

A 60-year-old previously healthy man was admitted to hospital with COVID-19 pneumonia that was treated initially with noninvasive ventilation, steroids and antibiotics. Six weeks after admission, the patient remained dependent on oxygen, using a highflow nasal cannula combined with a nonrebreather mask. Physical examination found proximal muscle wasting due to the long hospital stay. Computed tomography (CT) of his chest showed bilateral dense consolidations with superimposed interstitial and fibrotic changes. Because we thought the fibrosis was unlikely to resolve, we discussed the option of lung transplantation with him and his family, both of whom were interested in the procedure. An acute clinical deterioration subsequently led to his intubation, transfer to our extracorporeal life support (ECLS) centre and placement on veno-venous extracorporeal membrane oxygenation (V-V ECMO) as a bridge to transplantation. Seventeen days after ECMO cannulation, the patient underwent successful double lung transplantation with removal of the V-V ECMO immediately after transplant. On postoperative day 37, he no longer needed oxygen and we discharged him to a rehabilitation centre. At follow-up 5 months later, he was at home and did not require oxygen.

Case 2

A 53-year-old previously healthy man was admitted to hospital with COVID-19 pneumonia and received treatment with highflow nasal cannula oxygen, steroids and antibiotics. The patient was admitted to the intensive care unit (ICU) for 2 weeks but avoided intubation, improved clinically and was discharged to the ward on high-flow oxygen. Two weeks later, his condition deteriorated and CT showed extensive ground glass opacities, fibrosis and traction bronchiectasis in his lungs. We administered additional antibiotics, and he was intubated, paralyzed and proned. He was transferred to our ECLS centre and placed on V-V ECMO. Under ECMO support, he was extubated and participated in bedside physiotherapy. After no improvement in lung function after 7 weeks on ECMO and discussion with the patient and his family, we listed him for lung transplantation. Twenty-five days after listing, and 60 days after the start of ECMO, we performed a successful double-lung transplantation with removal of V-V ECMO immediately after transplant. We discharged the patient, no longer requiring oxygen, to our rehabilitation centre 25 days after the surgery. At follow-up 4 months later, he was at home and did not require oxygen.

Case 3

A 48-year-old man with a previous history of gout was admitted with severe a (B.1.1.7) variant COVID-19 pneumonia, intubated and, 5 days later, proned. The patient received treatment with steroids and antibiotics, and acquired severe acute kidney injury that required dialysis 6 days after intubation. His condition continued to deteriorate and he was transferred to our ECLS centre for V-V ECMO. He could not be extubated because of hypoxia and subsequently underwent tracheostomy. Five weeks after cannulation for ECMO, spontaneous rupture of 2 right lower branches of the pulmonary artery led to a large hemothorax, which we treated with massive transfusion and coiling of the artery branches. We drained the hemothorax by tube thoracostomy and administered tissue plasminogen activator to liquify organized clot and later converted...

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Gale Document Number: GALE|A677132929