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It is unknown if solid organ transplant recipients are at higher risk for severe COVID-19. The management of a lung transplantation (LTx) program and the therapeutic strategies to adapt the immunosuppressive regimen and antiviral measures is a major issue in the COVID-19 era, but little is known about worldwide practice. We sent out to 180 LTx centers worldwide in June 2020 a survey with 63 questions, both regarding the management of a LTx program in the COVID-19 era and the therapeutic strategies to treat COVID-19 LTx recipients. We received a total of 78 responses from 15 countries. Among participants, 81% declared a reduction of the activity and 47% restricted LTx for urgent cases only. Sixteen centers observed deaths on waiting listed patients and eight centers performed LTx for COVID-19 disease. In 62% of the centers, COVID-19 was diagnosed in LTx recipients, most of them not severe cases. The most common immunosuppressive management included a decreased dose or pausing of the cell cycle inhibitors. Remdesivir, hydroxychloroquine, and azithromycin were the most proposed antiviral strategies. Most of the centers have been affected by the COVID-19 pandemic and proposed an active therapeutic strategy to treat LTx recipients with COVID-19.

Additional file 1. Survey sent to the lung transplantation centers.

Thèse présentée sous la forme d'une "Thèse Article"; Introduction: Early, prolonged and repeated sessions of prone positioning (PP) have proven substantial outcome benefit in ARDS patients. In the most severe forms of ARDS, veno venous extracorporeal membrane oxygenation (vvECMO) is considered as a therapeutic option performed on a case by case. About 50% of patients treated with vvECMO have previously been turned prone. However, only few studies have evaluated the interest of maintaining PP during ECMO. Therefore, the objective of this study was to compare the 90-day survival rate of patients supported by vvECMO with concomitant PP (prone ECMO group) to those not turned prone during the ECMO period (ECMO alone group).Methods: We included all adults treated with vvECMO for ARDS between January 2012 and April 2017 in a university teaching hospital in Marseille, France. Patients were either cannulated in our ICU or in a referring hospital then transported by the ECMO mobile team. Before considering patients for ECMO, a PP session was systematically performed in our center if feasible, and strongly encouraged for patients from referral centers. Criteria for vvECMO have been previously published.During ECMO, patients were considered for prone position in case of 1/ persistent hypoxemia defined by SpO2 < 88 % or PaO2 < 55 mmHg despite a 100% FdO2 and FiO2 with a maximal ECMO blood flow, 2/ failure of attempt to wean ECMO after at least 10 days of ECMO and the presence of lung consolidations on chest X-ray or ultrasounds echography, 3/ according to the physician in charge.Technical issues have been previously described. We compared the prone ECMO group to the ECMO alone group. We performed Kaplan-Meier 90-day survival curves and Coxmodel for 90-day mortality.Results: 169 patients were included in the analysis, 92 in the prone group and 77 in the ECMO alone group. The prone group has a 57.6% 90-day survival rate as compared with a 37.7% 90-day survival rate of the ECMO alone group, p=0.01. SAPS2 [HR =1.040 (95% CI 1.024-1.056) and use of iNO before ECMO [HR = 1.86 (95% CI 1.156-2.992)] were independently associated with increase in 90-day mortality whereas the use of PP during ECMO was independently associated with decrease in 90-day mortality [HR=0.439 (95% CI 0.270-0.714)]Conclusion: The continuation of PP during vvECMO could be of clinical interest. Further prospective controlled study is warranted.; Introduction : au cours du syndrome de détresse respiratoire aiguë (SDRA) modéré à sévère, la réalisation de séances précoces, prolongées et répétées de décubitus ventral (DV) améliore le pronostic des patients via des effets physiologiques bénéfiques. Dans les formes les plus sévères de SDRA, en cas de contre-indication ou d’échec du recours au DV, l'utilisation de l’extracorporeal membrane oxygenation veino-veineuse (ECMO-vv) est une option thérapeutique qu’il faut considérer au cas par cas. Cinquante pourcent des patients assistés par ECMO-vv pour SDRA sévère ont bénéficié d’au moins une tentative de décubitus ventral. Cependant, peu d'études ont évalué l'intérêt de maintenir le DV pendant l'ECMO-vv. Par conséquent, l’objectif principal de cette étude était de comparer le taux de survie à 90 jours des patients qui ont eu du DV sous ECMO-vv (groupe ECMO DV) à ceux qui n’ont pas été mis en DV pendant la période d’utilisation de l’ECMO-vv (groupe ECMO seule).Méthodes : nous avons inclus tous les adultes traités avec ECMO-vv pour SDRA entre janvier 2012 et avril 2017 dans un hôpital universitaire à Marseille, France. Les patients ont été canulés dans notre service de réanimation ou dans un hôpital extérieur, puis transportés par l'UMAC (Unité Mobile d’Assistance Circulatoire). Avant d’envisager la mise en place d’une ECMO-vv, une séance de DV était systématiquement effectuée dans notre centre en l’absence de contre-indication et vivement encouragée pour les patients des centres extérieurs. Les critères pour la mise en place d’une ECMO-vv ont déjà été publiés. Les critères pour la réalisation de DV sous ECMO-vv étaient 1 / une hypoxémie persistante définie par SpO2