Deep in the lungs occupied by novel coronavirus! The first case of a new crown transplant in the United States has been confirmed. The recipient died two months later

Even if the throat swab and CT test are negative, it does not mean that there is no new crown.

A Michigan woman infected with a novel coronavirus after receiving a double lung transplant has died, the first confirmed case in the United States of an organ transplant, multiple media reported Monday.

A donor who died in a car crash donated both his lungs to a patient with chronic lung disease.
Before the surgery, the donor showed no signs of Covid-19 infection on routine viral tests and a CT scan.

However, the recipient died of Covid-19 infection 61 days after the transplant.

The hospital later found that the donor’s lung lavage sample was positive when it was tested, even though the surface test was fine.
In other words, the donor had been infected deep in his lungs by the novel coronavirus, an asymptomatic patient.

“We did everything we could to test and investigate to make sure the donor’s organ was safe, but unfortunately in this case, the standard tests proved ineffective,” said hospital chief Carr.

The donor’s family told doctors that he had no recent overseas travel history, had no contact with a known Covid-19 patient, and had no symptoms of Novel Coronavirus infection before the crash.

At the same time, the doctor who performed the transplant was also diagnosed with the infection.
Remember, in general, the doctor’s level of protection is highest during surgery.

The infection occurred three days after the transplant

The team at the University of Michigan Hospital recently reported the rare case in the American Journal of Transplantation: The recipient, a woman with chronic obstructive pulmonary disease, received a double lung transplant at the University of Michigan Hospital in the fall of 2020.
The donor was a woman in the Midwest who had been brain-dead in a car accident.

Prior to the surgery, the hospital had tested the donor for Novel Coronavirus and confirmed it was negative before performing the double lung transplant on the recipient woman.
However, 3 days after the transplant, the recipient developed symptoms of infection with novel coronavirus, and lung samples tested positive for novel coronavirus.

According to the hospital’s investigation, the donor was an asymptomatic infected person. Before the transplant, routine tests for Covid-19 virus were “done” twice, both of which were negative.
A CT scan of the lungs showed no signs of novel coronavirus infection.

However, the new crown of a donor alveolar lavage fluid sample kept at the hospital was positive.

The alveoli are located deep in the lungs, and traditional examinations can only reach the respiratory tract to the office

In other words, the new coronets from the donors were all negative under routine testing.
However, in a sample taken deep in the lungs, the test was positive.

Despite intensive treatment, including extracorporeal membrane oxygenation (ECMO), the recipient died 61 days after receiving the double lung transplant.

Nearly 40,000 transplants will be performed in the United States in 2020, and this woman is the only patient to be diagnosed with Covid-19 as a result of an organ transplant.

Dr. Daniel Kaul, chief of transplant infectious diseases at the University of Michigan Hospital, said it was an unfortunate case: “If we had a positive test for Novel coronavirus, we would never have used those lungs.”

Bruce Nicely, director of a local organ transplant foundation in Michigan, said: “While this case is rare, it represents the worst that could come next for us as health care workers.”

“All the screening is done.”

“It now appears that the donor is asymptomatic,” Dr. Carr said, but before the transplant, the hospital had done all the usual screening: a routine test for CoviD-19 “was done twice,” both negative;
A CT scan of the lungs showed no signs of novel coronavirus infection.

“Normally, even in asymptomatic people, 90 percent of them will be found to be infected on a test like this,” Carr said.

In addition, the hospital team learned about the donor’s clinical history and recent progress.
The donor’s family told doctors that he had no recent overseas travel history, had no contact with a known Covid-19 patient, and had no symptoms of Novel Coronavirus infection before the crash.

“We do everything we can to test and investigate to make sure the donor’s organ is safe, but unfortunately, in this case, standard tests proved ineffective.”
Carl said.

Three days after the transplant, the recipient developed fever, decreased blood pressure, and difficulty breathing. A mammogram revealed a lung infection, and doctors decided to screen her for Covid-19, which was positive.

Although the doctor gave the patient all the treatment, using antiviral drugs such as radecivir, using the serum of the Novel Coronavirus cure, and even into the extracorporeal membrane lung oxygenation technology, the patient’s condition continued to deteriorate, and even developed septic shock and heart problems. He died two months later.

The team at the University of Michigan Hospital decided to test samples from transplant donors.
It turned out that swab samples taken from the donor’s nose and throat were still negative.
But the hospital team had previously withheld a sample of the donor’s alveolar lavage fluid, which tested positive for Novel Coronavirus.

Novel Coronavirus detection generally includes upper respiratory tract samples (nasopharyngeal swabs, etc.) or lower respiratory tract samples (alveolar lavage fluid, etc.). Nasopharyngeal swabs are faster, less difficult and easy to operate.
Alveolar lavage fluid samples are usually collected by injecting saline into the bronchoalveoli and then aspirating it out.

Novel coronavirus has found a home deep in the lungs of many infected people

A respiratory doctor told the Times that a sample of alveolar lavage fluid, known as pulmonary lavage, is usually performed through bronchial intubation, which requires local anesthesia, and can even cause damage to the bronchial wall mucosa if it is not properly performed.
The operation is difficult and the cost is high, and it is impossible to popularize in a large area.

There has been some evidence that a pharyngeal swab of the upper respiratory tract may have a false negative result because the primary infection sites for novel coronavirus are actually the lower respiratory tract and lungs.

The surgeon was also infected

Remarkably, four days after the transplant, the thoracic surgeon who performed the organ transplant also tested positive for Covid-19.

A genetic comparison of the virus showed that both the woman with the lung disease and the surgeon had the virus from a donor who died in a car crash.

The surgeon, who has since recovered, believes he may have become infected after coming into contact with the donor’s lung mucus during the transplant, according to a report in the American Journal of Transplantation.

However, 10 other health care workers from the team involved in the surgery all tested negative for Novel Coronavirus.

Carr said the case, though rare, should serve as a wake-up call to health care workers around the world that more thorough screening of donors may be needed to prevent false negatives during the new epidemic.

Although this is the first confirmed case of transmission through an organ transplant in the United States, there are doubts that other similar cases could follow.
It also remains to be seen whether transplants of organs other than the lungs can still be infected.

Dr. Nisri worries that the case could pose a dilemma for health care workers: “Many patients will refuse transplants for fear of getting infected with novel coronavirus.”

Carr said that while the death was tragic, it was not a rejection of a transplant: “It’s not necessary to reject an organ for fear of a novel coronavirus.”

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