A center experience with lung transplantation for COVID-19 ARDS.

COVID-19 can cause irreversible lung damage from acute respiratory distress syndrome (ARDS), chronic respiratory failure associated with post COVID-19 de novo fibrosis or worsening of an underlying fibrotic lung disease. Pregnant women are at increased risk for invasive mechanical ventilation, extracorporeal membrane oxygenation, and death. The Centers for Disease Control and Prevention reported more than 22,000 hospitalizations and 161 deaths for COVID-19 in pregnant women. Between August 2020 and September 2021, five patients underwent bilateral lung transplant (LT) for COVID-19 ARDS at the Henry Ford Hospital in Detroit, Michigan. De-identified demographics data, clinical characteristics, perioperative challenges, explanted lung pathology, and post-transplant outcomes are described. In post-hospitalization follow-up (median survival 273 days), we see improving endurance and excellent lung function. One patient did not survive to hospital discharge and succumbed to complications 5 months after LT. We report the first cases of bilateral LT in two postpartum women.

Evaluation of a dedicated pharmacist staffing model in the medical intensive care unit.

PURPOSE: Published studies have shown that pharmacists on medical rounds reduce the incidence of preventable adverse drug events (ADEs). However, the impact of a dedicated pharmacist who provides consistent patient care in a critical care unit remains to be evaluated. OBJECTIVE: To determine the impact of a pharmacist who is permanently assigned to the medical intensive care unit (MICU) on the incidence of preventable ADEs, drug charges, and length of stay (LOS) in the MICU. DESIGN: A randomized, experimental versus historical control group design was used. Preventable ADEs were identified and validated by 2 pharmacists and a critical care physician. Information about MICU drug charges and LOS were obtained from the hospital administrative database. RESULTS: The intervention group had fewer occurrences of ADEs (10 ADEs/1,000 patient days) when compared to the control group (28 ADEs/1,000 patient days) at a significance level of .03. No significant differences were found between the 2 groups in MICU drug charges and LOS. The vast majority of the 596 documented recommended interventions (99%) were accepted by the medical team. Nutrition monitoring, medication indicated but not prescribed, and dosage modification were the top 3 problems identified by the pharmacist. CONCLUSION: The addition of a dedicated critical care pharmacist to the MICU medical team improves the safe use of medication. The services of a dedicated critical care pharmacist should be expanded to include weekend hours to ensure the benefits of improved medication safety.

Timing of basiliximab induction and development of acute rejection in lung transplant patients.

BACKGROUND: Acute rejection affects more than 36% of recipients within the first year post-transplantation. The interleukin-2 (IL-2) receptor antagonist basiliximab has been associated with decreased frequency and severity of acute rejection. We investigated whether the timing of induction administration would impact the frequency and severity of acute rejection in the first year after transplantation. METHODS: In this study we reviewed 119 patients who underwent lung transplantation at Henry Ford Hospital from October 1994 to January 2009. Prior to January 2000 no patients received induction. From January 2000 to March 2006 the initial dose was given after implantation, and from March 2006 to 2009 basiliximab was given prior to implantation. The primary outcome was cumulative acute rejection score (CAR) in the first post-operative year comparing post- vs pre-implant induction. RESULTS: The CAR score for pre-implant basiliximab was 2.5 ± 2.3. This was significantly lower than CAR score of 4.6 ± 3.9 in the post-implant group (p = 0.025). The no-induction group had the highest CAR score at 6.3 ± 3.8 (p = 0.077 compared with the post group). The mean follow-up times in the post and pre group were 5.9 ± 2.3 and 2.3 ± 0.7 years, respectively (p < 0.001). There was no difference in freedom from bronchiolitis obliterans syndrome (BOS), survival or invasive infections between pre- and post-implant induction groups. CONCLUSIONS: Basiliximab prior to implant is associated with a lower cumulative acute rejection score over 1 year compared with induction post-implantation. Despite a lower cumulative acute rejection score, there was no significant difference in freedom from BOS or survival.

Transfer of peanut allergy from the donor to a lung transplant recipient.

Among solid organs, transfer of peanut allergy from donor to recipient has been implicated after liver transplantation. We report the first case in which such transfer occurred after a lung transplant. A 42-year-old woman with history of sarcoidosis underwent a successful bilateral lung transplant from a donor who died from anaphylactic shock after eating peanut-related food. Seven months later, she ate a peanut butter cookie at a transplant support group meeting. Immediately thereafter, she developed an anaphylactic reaction, but survived with prompt treatment. During subsequent follow-up, she could recall three prior episodes of wheezing and difficulty breathing after eating peanut-related foods. The first episode occurred 4 days after the transplant. Prior to her transplant, she never had problems eating peanuts. Skin-prick testing confirmed peanut sensitization. She avoided peanuts and, although her skin-prick test became negative, she still manifested peanut allergy when formally challenged orally with the food. She was advised to continue abstaining from all peanut-related foods. This case emphasizes the importance of considering donor allergy transfer when caring for all solid-organ transplant recipients in order to avoid a life-threatening event.