Med (New York, N.Y.) · 2026
Bridge to transplant using a flow-adaptive extracorporeal total artificial lung system following bilateral pneumonectomy.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
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Ошибки и ограничения
История · было → стало
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Yan Yuanqing, Chandrasekhar Anitha, Yang Hee Chul, Devarakonda Teja, Reynolds Aaron, Yeldandi Anjana V, Arunachalam Ambalavanan, Kurihara Chitaru, Budinger G R Scott, Bharat Ankit
Аннотация
BACKGROUND: Severe acute respiratory distress syndrome (ARDS) complicated by necrotizing pneumonia and septic shock carries a mortality exceeding 80%. Lung transplantation is rarely pursued because persistent sepsis, uncertainty regarding the reversibility of parenchymal injury, and profound hemodynamic instability preclude candidacy.
METHODS: We developed an extracorporeal total artificial lung (TAL) system to enable bilateral pneumonectomy for source control in a patient with ARDS complicated by necrotizing pneumonia and refractory septic shock. The system incorporated a flow-adaptive right pulmonary artery-to-right atrial shunt to compensate for loss of pulmonary vascular capacitance, extracorporeal oxygenation, and dual left atrial return conduits to maintain physiologic transcardiac blood flow. In parallel, we performed single-cell and spatial transcriptomic profiling of the explanted lungs to define associated cellular and molecular changes.
FINDINGS: Following pneumonectomy, vasopressor requirements resolved, and the patient remained fully supported until transplant. Transcriptomic profiling revealed diffuse, uniform destruction across all regions, with dense infiltration by neutrophils, monocyte-derived alveolar macrophages, and activated T cells. These inflammatory changes coexisted with marked expansion of aberrant basaloid epithelial cells and CTHRC1-positive myofibroblasts, with near-complete loss of normal alveolar architecture. Molecular signatures recapitulated end-stage fibrotic lung disease and were consistent with irreversible injury rather than a recoverable ARDS phenotype. The patient demonstrates excellent cardiopulmonary function 2 years after transplantation.
CONCLUSIONS: An extracorporeal TAL system can permit safe bilateral pneumonectomy for source control in otherwise non-transplantable patients with medically refractory pneumonia, providing a viable salvage strategy to bridge selected patients to successful lung transplantation.
FUNDING: This project was funded through NIH grants HL145478, HL147575, HL173940, and P0HL169188.
METHODS: We developed an extracorporeal total artificial lung (TAL) system to enable bilateral pneumonectomy for source control in a patient with ARDS complicated by necrotizing pneumonia and refractory septic shock. The system incorporated a flow-adaptive right pulmonary artery-to-right atrial shunt to compensate for loss of pulmonary vascular capacitance, extracorporeal oxygenation, and dual left atrial return conduits to maintain physiologic transcardiac blood flow. In parallel, we performed single-cell and spatial transcriptomic profiling of the explanted lungs to define associated cellular and molecular changes.
FINDINGS: Following pneumonectomy, vasopressor requirements resolved, and the patient remained fully supported until transplant. Transcriptomic profiling revealed diffuse, uniform destruction across all regions, with dense infiltration by neutrophils, monocyte-derived alveolar macrophages, and activated T cells. These inflammatory changes coexisted with marked expansion of aberrant basaloid epithelial cells and CTHRC1-positive myofibroblasts, with near-complete loss of normal alveolar architecture. Molecular signatures recapitulated end-stage fibrotic lung disease and were consistent with irreversible injury rather than a recoverable ARDS phenotype. The patient demonstrates excellent cardiopulmonary function 2 years after transplantation.
CONCLUSIONS: An extracorporeal TAL system can permit safe bilateral pneumonectomy for source control in otherwise non-transplantable patients with medically refractory pneumonia, providing a viable salvage strategy to bridge selected patients to successful lung transplantation.
FUNDING: This project was funded through NIH grants HL145478, HL147575, HL173940, and P0HL169188.