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Question Addressed by the Study: Do three coronavirus disease 2019 (COVID-19) vaccine doses induce a serological response in lung transplant recipients?, Methods: We retrospectively included 1071 adults (551 (52%) males) at nine transplant centres in France. Each had received three COVID-19 vaccine doses in 2021, after lung transplantation. An anti-spike protein IgG response, defined as a titre >264 BAU·mL -1 after the third dose (median (interquartile range (IQR)) 3.0 (1.7-4.1) months), was the primary outcome and adverse events were the secondary outcomes. Median (IQR) age at the first vaccine dose was 54 (40-63) years and median (IQR) time from transplantation to the first dose was 64 (30-110) months., Results: Median (IQR) follow-up after the first dose was 8.3 (6.7-9.3) months. A vaccine response developed in 173 (16%) patients. Factors independently associated with a response were younger age at vaccination, longer time from transplantation to vaccination and absence of corticosteroid or mycophenolate therapy. After vaccination, 51 (5%) patients (47 non-responders (47/898 (5%)) and four (4/173 (2%)) responders) experienced COVID-19, at a median (IQR) of 6.6 (5.1-7.3) months after the third dose. No responders had severe COVID-19 compared with 15 non-responders, including six who died of the disease., Conclusions: Few lung transplant recipients achieved a serological response to three COVID-19 vaccine doses, indicating a need for other protective measures. Older age and use of mycophenolate or corticosteroids were associated with absence of a response. The low incidence of COVID-19 might reflect vaccine protection via cellular immunity and/or good adherence to shielding measures., Competing Interests: Conflict of interest: None for any authors., (Copyright ©The authors 2023.)

Background: The published experience of lung transplantation in acute respiratory distress syndrome (ARDS) is limited. The aim of this study was to investigate the contemporary results of lung transplantation attempts in ARDS in major European centres., Methods: We conducted a retrospective multicentre cohort study of all patients listed for lung transplantation between 2011 and 2019. We surveyed 68 centres in 22 European countries. All patients admitted to the waitlist for lung transplantation with a diagnosis of "ARDS/pneumonia" were included. Patients without extracorporeal membrane oxygenation (ECMO) or mechanical ventilation were excluded. Patients were followed until 1 October 2020 or death. Multivariable analysis for 1-year survival after listing and lung transplantation was performed., Results: 55 centres (81%) with a total transplant activity of 12 438 lung transplants during the 9-year period gave feedback. 40 patients with a median age of 35 years were identified. Patients were listed for lung transplantation in 18 different centres in 10 countries. 31 patients underwent lung transplantation (0.25% of all indications) and nine patients died on the waitlist. 90% of transplanted patients were on ECMO in combination with mechanical ventilation before lung transplantation. On multivariable analysis, transplantation during 2015-2019 was independently associated with better 1-year survival after lung transplantation (OR 10.493, 95% CI 1.977-55.705; p=0.006). 16 survivors out of 23 patients with known status (70%) returned to work after lung transplantation., Conclusions: Lung transplantation in highly selected ARDS patients is feasible and outcome has improved in the modern era. The selection process remains ethically and technically challenging., Competing Interests: Conflict of interest: J. Gottlieb reports grants from the German Center for Lung Research (DZL), during the conduct of the study; grants from Deutsche Forschungsgemeinschaft (DFG) and from Breath Therapeutics, personal fees from Novartis, outside the submitted work. Conflict of interest: P.M. Lepper has nothing to disclose. Conflict of interest: C. Berastegui has nothing to disclose. Conflict of interest: B. Montull has nothing to disclose. Conflict of interest: A. Wald has nothing to disclose. Conflict of interest: J. Parmar reports nonfinancial support from Breath Therapeutics, outside the submitted work. Conflict of interest: J.M. Magnusson reports personal fees from GSK, grants and personal fees from Boehringer Ingelheim, outside the submitted work. Conflict of interest: F. Schönrath reports grants from Novartis and Abbott, nonfinancial support from Medtronic, other from AstraZeneca and Orion Pharma, outside the submitted work. Conflict of interest: T. Laisaar has nothing to disclose. Conflict of interest: S. Michel reports grants from the German Center for Lung Research (DZL), during the conduct of the study; grants from Deutsche Forschungsgemeinschaft (DFG), outside the submitted work. Conflict of interest: H. Larsson has nothing to disclose. Conflict of interest: R. Vos reports grants from Research Foundation-Flanders (FWO), outside the submitted work. Conflict of interest: A. Haneya has nothing to disclose. Conflict of interest: T. Sandhaus has nothing to disclose. Conflict of interest: E. Verschuuren has nothing to disclose. Conflict of interest: J. le Pavec has nothing to disclose. Conflict of interest: J. Tikkanen reports personal fees from Astellas Pharma, GSK pharma and CSL Behring, outside the submitted work. Conflict of interest: K. Hoetzenecker reports grants from FWF Austria, personal fees from Medtronic, outside the submitted work., (Copyright ©The authors 2022. For reproduction rights and permissions contact permissions@ersnet.org.)

Data on treatment of patients with portopulmonary hypertension (PoPH) are limited, as they are usually excluded from randomised controlled trials with pulmonary arterial hypertension (PAH)-specific therapies. This study investigated the short- and long-term efficacy/safety of bosentan in these patients, as well as its pharmacokinetics. All 34 consecutive patients with PoPH treated with first-line bosentan (December 2002 to July 2009) were retrospectively evaluated. Assessments included the New York Heart Association functional class (NYHA FC), blood tests, haemodynamics, 6-min walk distance (6MWD) and event-free status. The pharmacokinetics of bosentan in five patients with Child-Pugh (C-P) class B cirrhosis were compared with idiopathic PAH patients. Significant improvements from baseline were observed in NYHA FC, 6 MWD and haemodynamics, and were largely maintained during follow-up. Patients with C-P class B cirrhosis (n=9) had significantly larger haemodynamic improvement after mean ± SD 5 ± 2 months. Mean follow-up time was 43 ± 19 months; four patients died and seven patients had significant elevation of liver enzymes (annual rate 5.5%). Plasma concentrations of bosentan were higher in patients with C-P class B cirrhosis than those observed in idiopathic PAH. These data confirm the benefit of bosentan treatment for patients with PoPH. Haemodynamic improvements were particularly pronounced in patients with more severe cirrhosis. The safety profile of bosentan was consistent with previous studies.