Bilateral Lung Transplantation With Donor Positive for COVID-19 Infection on Bronchoalveolar Lavage: A Case Report.

Initial experience with lung transplant of COVID-19-positive donors was marked by disappointing results, including a reported case of mortality through donor to recipient transmission of infection. However, since that time a number of improvements in preventative and therapeutic measures against COVID-19 have been developed. We present the case of a 51-year-old woman with scleroderma-associated interstitial lung disease who was awaiting lung transplant. A potential donor with excellent lung physiology was located; however, initial testing on bronchoalveolar lavage (BAL) was positive for COVID-19. The donor had tested positive 2 weeks prior and had symptomatically recovered. Our patient had been fully vaccinated but not seroconverted. Given the history of a donor with recovering COVID infection and a fully immunized recipient, our multidisciplinary team elected to proceed with the transplant. The patient successfully underwent bilateral lung transplant with standard induction immunosuppression. Bebtelovimab was given post-transplant day 1 because the recipient remained seronegative to COVID-19. Serial bronchoalveolar lavages post transplant have been negative for COVID-19. The patient has done well after transplant. She was seen in the clinic 2 months post transplant and is ambulatory without supplemental oxygen requirements. To our knowledge, this represents the first reported successful case of lung transplant with a donor positive for COVID-19 on lower respiratory tract sampling.

Histologic characteristics of coronary artery fatty streaks

The histologic characterictics of a standard site in the left interior descending coronary artery of 304 males between 10 and 39 years of age from seven different populations were examined. These seven location-race groups were ranked in the same order as the ranking based upon mean extent of raised atherosclerotic lesions in the coronary arteries and aorta to establish the tendency of each group to develop advanced atherosclerosis. Muscloelastic intimal thickening in the earlier decades does not predict the likelihood to develop severe atherosclerosis. Amount of intimal lipid and degree of cellular infiltration do predict the disposition to develop severe atherosclerosis later in life. Therefore, increased intimal lipid and cellular infiltration characterize coronary artery fatty streaks that are associated with their conversion to fibrous plaques. Necrosis of lipid-containing cells may release intracellular lipid into the extracellular space and thereby incite cellular infiltration and sequelae. (AU)