COVID-19 after lung transplantation: Four case reports_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WANG Hongyi , LI Yixing , ZHAO Heng , ZHANG Yanpeng , GAO Shan , WANG Jizhao , ZHAO Yilong , LI Shuo ,  ZHANG Guangjian

Department of Thoracic Surgery, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, 710061, P. R. China;

Corresponding author：

ZHANG Guangjian, Email: micheal8039@xjtu.edu.cn

Keywords：

Lung transplantation; coronavirus disease 2019; immunosuppression adjustment; antiviral drug; case report

DOI：

10.7507/1007-4848.202306010

Video：

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From December 2022 to January 2023, 4 lung transplant recipients (3 males and 1 female, aged 52-60 years, all received transplantation less than 1 year) were hospitalized in the Department of Thoracic Surgery of the First Affiliated Hospital of Xi'an Jiaotong University due to COVID-19 after surgery. The clinical manifestations were mostly characterized by elevated body temperature accompanied by shortness of breath, and indicators such as heart rate, oxygen saturation, and oxygenation index could reflect the severity of the condition. The therapy was timely adjusted to immunosuppressive drugs, upgraded oxygen therapy, anti-bacterial and anti-fungal therapy, prone ventilation, general treatment, and anticoagulant therapy, depending on the situation. Finally, 3 patients were cured and discharged from hospital, and 1 died.

Citation： WANG Hongyi, LI Yixing, ZHAO Heng, ZHANG Yanpeng, GAO Shan, WANG Jizhao, ZHAO Yilong, LI Shuo, ZHANG Guangjian. COVID-19 after lung transplantation: Four case reports. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(11): 1697-1702. doi: 10.7507/1007-4848.202306010 Copy

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11.	陈道南, 田锐, 王瑞兰. 清醒俯卧位通气和新型冠状病毒肺炎. 中国中西医结合急救杂志, 2022, 29(1): 104-106.Chen DN, Tian R, Wang RL. Prone positioning ventilation for awake patients with coronavirus disease 2019. Chin J Integr Trad West Med Intens Crit Care, 2022, 29(1): 104-106.
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15.	黄倩, 陈松, 刘斌, 等. 肾移植受者继发新型冠状病毒感染免疫抑制方案的调整. 临床外科杂志, 2021, 29(4): 385-387.Huang Q, Chen S, Liu B, et al. Modification of immunosuppressive regimens for coronavirus disease 2019 infection secondary to renal transplantation recipients. J Clin Surg, 2021, 29(4): 385-387.
16.	Zhu L, Xu X, Ma K, et al. Successful recovery of COVID-19 pneumonia in a renal transplant recipient with long-term immunosuppression. Am J Transplant, 2020, 20(7): 1859-1863.
17.	胡瑞, 邱文龙, 赵喜红, 等. 从肾移植术后感染新冠肺炎谈免疫宿主低下人群的管理. 中华危重病急救医学, 2022, 34(5): 492-496.Hu R, Qiu WL, Zhao XH, et al. Management of immunocompromised renal transplant patients infected with coronavirus disease 2019. Chin Crit Care Med, 2022, 34(5): 492-496.
18.	王欢, 张铖. 口服新型冠状病毒肺炎治疗新药—Paxlovid. 临床药物治疗杂志, 2022, 20(2): 13-17.Wang H, Zhang C. Novel oral drug for the treatment of corona virus disease 2019—Paxlovid. Clin J Med, 2022, 20(2): 13-17.
19.	陈洋洋, 陈伟. 抗新型冠状病毒新药奈玛特韦片/利托那韦片的药理作用机制和临床研究分析. 江苏大学学报(医学版), 2022, 32(6): 537-541, 545.Chen YY, Chen W. Pharmacological mechanism and clinical analysis of Nematavir tablet/Ritonavir tablet for anti-novel coronavirus. J Jiangsu Univ (Med Edit), 2022, 32(6): 537-541, 545.
20.	乔海灵, 胡玉荣, 柴淑贞, 等. 利托那韦口服液在健康人体的药代动力学和生物等效性. 中国临床药理学杂志, 2006, 22(5): 332-335.Qiao HL, Hu YR, Chai SZ, et al. Pharmacokinetics and bioequivalence of ritonavir solutions in healthy volunteers. Chin J Clin Pharmacol, 2006, 22(5): 332-335.
21.	蒋建东. 抗新冠病毒新药阿兹夫定研究. 中国医药导刊, 2022, 24(10): 947-948.Jiang JD. Research on the new drug Azvudine against the novel coronavirus. Chin J Med Guide, 2022, 24(10): 947-948.
22.	Zhang JL, Li YH, Wang LL, et al. Azvudine is a thymus-homing anti-SARS-CoV-2 drug effective in treating COVID-19 patients. Signal Transduct Target Ther, 2021, 6(1): 414.
23.	Liu Y, Wang Y, Peng Y, et al. Effects of the antiretroviral drug 2'-deoxy-2'-β-fluoro-4'-azidocytidine (FNC) on P-gp, MRP2 and BCRP expressions and functions. Pharmazie, 2018, 73(9): 503-507.
24.	Mahajan S, Kohli HS, Gupta KL, et al. Infection Prevention and Control Guidelines for COVID. Indian J Nephrol, 2020, 30(3): 185-187.

1. Telenti A, Arvin A, Corey L, et al. After the pandemic: Perspectives on the future trajectory of COVID-19. Nature, 2021, 596(7873): 495-504.
2. 中华人民共和国国家卫生健康委员会. 新型冠状病毒感染诊疗方案(试行第十版). 中华临床感染病杂志, 2023, 16(1): 1-9.National Health Commission of the People's Republic of China. Diagnosis and treatment plan for COVID-19 (trial version 10). Chin J Clin Infect Dis, 2023, 16(1): 1-9.
3. 巨春蓉, 李宁, 邱涛, 等. 器官移植受者新型冠状病毒肺炎的临床特点和疫情期间的管理策略(第1版). 器官移植, 2020, 11(2): 185-193.Ju CR, Li N, Qiu T, et al. Clinical characteristics of novel coronavirus pneumonia in organ transplant recipients and management strategy during the epidemic (1st edition). Organ Transplant, 2020, 11(2): 185-193.
4. 国家传染病医学中心, 中华医学会器官移植学分会, 中国康复医学会器官移植康复专业委员会, 等. 实体器官移植受者新型冠状病毒感染诊疗专家共识(2023年版). 器官移植, 2023, 14(2): 163-182.Medical Center for Infectious Diseases, Branch of Organ Transplantation of Chinese Medical Association, Organ Transplant Rehabilitation Committee of China Association Rehabilitation Medicine, et al. Expert consensus on diagnosis and treatment of SARS-CoV-2 infection in solid organ transplant recipients (2023 edition). Organ Transplant, 2023, 14(2): 163-182.
5. 巨春蓉, 徐鑫, 薛武军. 实体器官移植受者感染新型冠状病毒的诊疗策略. 器官移植, 2023, 14(2): 183-193.Ju CR, Xu X, Xue WJ. Diagnosis and treatment strategies for solid organ transplant recipients with SARS-CoV-2 infection. Organ Transplant, 2023, 14(2): 183-193.
6. 吴姗姗, 朱丽萍, 杜北珏, 等. 新型冠状病毒肺炎的临床表现及CT影像学特点. 中国CT和MRI杂志, 2022, 20(6): 71-73.Wu SS, Zhu LP, Du BJ, et al. Analysis of the clinical manifestations and CT imaging features of COVID-19. Chin J CT MRI, 2022, 20(6): 71-73.
7. 陈松, 张伟杰, 陈刚, 等. 器官移植受者2019新型冠状病毒感染临床诊疗工作指导意见(第一版). 中华器官移植杂志, 2020, 41(3): 136-139.Chen S, Zhang WJ, Chen G, et al. Guidance on clinical diagnosis, treatment and transplant associated works of coronavirus disease 2019 in organ transplant recipients. Chin J Organ Transplant, 2020, 41(3): 136-139.
8. Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med, 2020, 382(18): 1708-1720.
9. Boyarsky BJ, Werbel WA, Avery RK, et al. Antibody response to 2-dose SARS-CoV-2 mRNA vaccine series in solid organ transplant recipients. JAMA, 2021, 325(21): 2204-2206.
10. Prince MR, Dev H, Lane EG, et al. Major hemorrhage and mortality in COVID-19 patients on therapeutic anticoagulation for venous thromboembolism. J Thromb Thrombolysis, 2022, 54(3): 431-437.
11. 陈道南, 田锐, 王瑞兰. 清醒俯卧位通气和新型冠状病毒肺炎. 中国中西医结合急救杂志, 2022, 29(1): 104-106.Chen DN, Tian R, Wang RL. Prone positioning ventilation for awake patients with coronavirus disease 2019. Chin J Integr Trad West Med Intens Crit Care, 2022, 29(1): 104-106.
12. Coppo A, Bellani G, Winterton D, et al. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): A prospective cohort study. Lancet Respir Med, 2020, 8(8): 765-774.
13. 邱涛, 王竞悦, 周江桥, 等. 肾移植术后2019新型冠状病毒感染二例并文献分析. 中华器官移植杂志, 2020, 41(3): 140-143.Qiu T, Wang JY, Zhou JQ, et al. Two cases infected with novel coronavirus (2019-nCoV) after kidney transplantation and a review of related literature. Chin J Organ Transplant, 2020, 41(3): 140-143.
14. 涂亚芳, 吴雄飞, 刘锋, 等. 肾移植受者继发新型冠状病毒肺炎二例临床报告. 中华器官移植杂志, 2020, 41(3): 144-147.Tu YF, Wu XF, Liu F, et al. Two clinical cases of novel coronavirus pneumonia (COVID-19) in renal transplant recipients. Chin J Organ Transplant, 2020, 41(3): 144-147.
15. 黄倩, 陈松, 刘斌, 等. 肾移植受者继发新型冠状病毒感染免疫抑制方案的调整. 临床外科杂志, 2021, 29(4): 385-387.Huang Q, Chen S, Liu B, et al. Modification of immunosuppressive regimens for coronavirus disease 2019 infection secondary to renal transplantation recipients. J Clin Surg, 2021, 29(4): 385-387.
16. Zhu L, Xu X, Ma K, et al. Successful recovery of COVID-19 pneumonia in a renal transplant recipient with long-term immunosuppression. Am J Transplant, 2020, 20(7): 1859-1863.
17. 胡瑞, 邱文龙, 赵喜红, 等. 从肾移植术后感染新冠肺炎谈免疫宿主低下人群的管理. 中华危重病急救医学, 2022, 34(5): 492-496.Hu R, Qiu WL, Zhao XH, et al. Management of immunocompromised renal transplant patients infected with coronavirus disease 2019. Chin Crit Care Med, 2022, 34(5): 492-496.
18. 王欢, 张铖. 口服新型冠状病毒肺炎治疗新药—Paxlovid. 临床药物治疗杂志, 2022, 20(2): 13-17.Wang H, Zhang C. Novel oral drug for the treatment of corona virus disease 2019—Paxlovid. Clin J Med, 2022, 20(2): 13-17.
19. 陈洋洋, 陈伟. 抗新型冠状病毒新药奈玛特韦片/利托那韦片的药理作用机制和临床研究分析. 江苏大学学报(医学版), 2022, 32(6): 537-541, 545.Chen YY, Chen W. Pharmacological mechanism and clinical analysis of Nematavir tablet/Ritonavir tablet for anti-novel coronavirus. J Jiangsu Univ (Med Edit), 2022, 32(6): 537-541, 545.
20. 乔海灵, 胡玉荣, 柴淑贞, 等. 利托那韦口服液在健康人体的药代动力学和生物等效性. 中国临床药理学杂志, 2006, 22(5): 332-335.Qiao HL, Hu YR, Chai SZ, et al. Pharmacokinetics and bioequivalence of ritonavir solutions in healthy volunteers. Chin J Clin Pharmacol, 2006, 22(5): 332-335.
21. 蒋建东. 抗新冠病毒新药阿兹夫定研究. 中国医药导刊, 2022, 24(10): 947-948.Jiang JD. Research on the new drug Azvudine against the novel coronavirus. Chin J Med Guide, 2022, 24(10): 947-948.
22. Zhang JL, Li YH, Wang LL, et al. Azvudine is a thymus-homing anti-SARS-CoV-2 drug effective in treating COVID-19 patients. Signal Transduct Target Ther, 2021, 6(1): 414.
23. Liu Y, Wang Y, Peng Y, et al. Effects of the antiretroviral drug 2'-deoxy-2'-β-fluoro-4'-azidocytidine (FNC) on P-gp, MRP2 and BCRP expressions and functions. Pharmazie, 2018, 73(9): 503-507.
24. Mahajan S, Kohli HS, Gupta KL, et al. Infection Prevention and Control Guidelines for COVID. Indian J Nephrol, 2020, 30(3): 185-187.

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