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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6.	吳姍姍, 朱麗萍, 杜北玨, 等. 新型冠狀病毒肺炎的臨床表現及CT影像學特點. 中國CT和MRI雜志, 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.
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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.	陳道南, 田銳, 王瑞蘭. 清醒俯臥位通氣和新型冠狀病毒肺炎. 中國中西醫結合急救雜志, 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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13.	邱濤, 王競悅, 周江橋, 等. 腎移植術后2019新型冠狀病毒感染二例并文獻分析. 中華器官移植雜志, 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.	涂亞芳, 吳雄飛, 劉鋒, 等. 腎移植受者繼發新型冠狀病毒肺炎二例臨床報告. 中華器官移植雜志, 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.	黃倩, 陳松, 劉斌, 等. 腎移植受者繼發新型冠狀病毒感染免疫抑制方案的調整. 臨床外科雜志, 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, 邱文龍, 趙喜紅, 等. 從腎移植術后感染新冠肺炎談免疫宿主低下人群的管理. 中華危重病急救醫學, 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.	王歡, 張鋮. 口服新型冠狀病毒肺炎治療新藥—Paxlovid. 臨床藥物治療雜志, 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.	陳洋洋, 陳偉. 抗新型冠狀病毒新藥奈瑪特韋片/利托那韋片的藥理作用機制和臨床研究分析. 江蘇大學學報(醫學版), 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.	喬海靈, 胡玉榮, 柴淑貞, 等. 利托那韋口服液在健康人體的藥代動力學和生物等效性. 中國臨床藥理學雜志, 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.	蔣建東. 抗新冠病毒新藥阿茲夫定研究. 中國醫藥導刊, 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. 中華人民共和國國家衛生健康委員會. 新型冠狀病毒感染診療方案(試行第十版). 中華臨床感染病雜志, 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, 李寧, 邱濤, 等. 器官移植受者新型冠狀病毒肺炎的臨床特點和疫情期間的管理策略(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. 國家傳染病醫學中心, 中華醫學會器官移植學分會, 中國康復醫學會器官移植康復專業委員會, 等. 實體器官移植受者新型冠狀病毒感染診療專家共識(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, 薛武軍. 實體器官移植受者感染新型冠狀病毒的診療策略. 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. 吳姍姍, 朱麗萍, 杜北玨, 等. 新型冠狀病毒肺炎的臨床表現及CT影像學特點. 中國CT和MRI雜志, 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. 陳松, 張偉杰, 陳剛, 等. 器官移植受者2019新型冠狀病毒感染臨床診療工作指導意見(第一版). 中華器官移植雜志, 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. 陳道南, 田銳, 王瑞蘭. 清醒俯臥位通氣和新型冠狀病毒肺炎. 中國中西醫結合急救雜志, 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. 邱濤, 王競悅, 周江橋, 等. 腎移植術后2019新型冠狀病毒感染二例并文獻分析. 中華器官移植雜志, 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. 涂亞芳, 吳雄飛, 劉鋒, 等. 腎移植受者繼發新型冠狀病毒肺炎二例臨床報告. 中華器官移植雜志, 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. 黃倩, 陳松, 劉斌, 等. 腎移植受者繼發新型冠狀病毒感染免疫抑制方案的調整. 臨床外科雜志, 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, 邱文龍, 趙喜紅, 等. 從腎移植術后感染新冠肺炎談免疫宿主低下人群的管理. 中華危重病急救醫學, 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. 王歡, 張鋮. 口服新型冠狀病毒肺炎治療新藥—Paxlovid. 臨床藥物治療雜志, 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. 陳洋洋, 陳偉. 抗新型冠狀病毒新藥奈瑪特韋片/利托那韋片的藥理作用機制和臨床研究分析. 江蘇大學學報(醫學版), 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. 喬海靈, 胡玉榮, 柴淑貞, 等. 利托那韋口服液在健康人體的藥代動力學和生物等效性. 中國臨床藥理學雜志, 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. 蔣建東. 抗新冠病毒新藥阿茲夫定研究. 中國醫藥導刊, 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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