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Lung transplantation for pulmonary fibrosis secondary to severe COVID-19
- Source :
- medRxiv
- Publication Year :
- 2020
- Publisher :
- Cold Spring Harbor Laboratory, 2020.
-
Abstract
- 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 viral-mediated injury to the native lung, and potential risk for allograft infection by pathogens associated with ventilator-induced pneumonia in the native lung. Additionally, the native lung might recover, resulting in long-term outcomes preferable to transplant. Here, we report the results of the first two successful lung transplantation procedures in patients with non-resolving COVID-19 associated acute respiratory distress syndrome in the United States. We performed smFISH to detect both positive and negative strands of SARS-CoV-2 RNA in the explanted lung tissue, extracellular matrix imaging using SHIELD tissue clearance, and single cell RNA-Seq on explant and warm post-mortem lung biopsies from patients who died from severe COVID-19 pneumonia. Lungs from patients with prolonged COVID-19 were free of virus but pathology showed extensive evidence of injury and fibrosis which resembled end-stage pulmonary fibrosis. Single cell RNA-Seq of the explanted native lungs from transplant and paired warm post-mortem autopsies showed similarities between late SARS-CoV-2 acute respiratory distress syndrome and irreversible end-stage pulmonary fibrosis requiring lung transplantation. There was no recurrence of SARS-CoV-2 or pathogens associated with pre-transplant ventilator associated pneumonias following transplantation in either patient. Our findings suggest that some patients with severe COVID-19 develop fibrotic lung disease for which lung transplantation is the only option for survival.Single sentence summarySome patients with severe COVID-19 develop end-stage pulmonary fibrosis for which lung transplantation may be the only treatment.
- Subjects :
- Adult
Male
medicine.medical_specialty
Databases, Factual
medicine.medical_treatment
Pulmonary Fibrosis
Gastroenterology
Severity of Illness Index
Virus
Article
Extracellular matrix
Fibrosis
Internal medicine
Pulmonary fibrosis
medicine
Lung transplantation
Humans
RNA-Seq
Lung
In Situ Hybridization, Fluorescence
Retrospective Studies
Aged, 80 and over
business.industry
COVID-19
Recovery of Function
respiratory system
Middle Aged
medicine.disease
respiratory tract diseases
Transplantation
Pneumonia
medicine.anatomical_structure
Treatment Outcome
COVID-19 Nucleic Acid Testing
Disease Progression
Female
Single-Cell Analysis
business
Lung Transplantation
Subjects
Details
- Language :
- English
- Database :
- OpenAIRE
- Journal :
- medRxiv
- Accession number :
- edsair.doi.dedup.....7df10c56c0c3541803a6a16eacd50961