Acute worsening of native lung fibrosis after single lung transplantation for pulmonary fibrosis: two case reports

Abstract

Background In patients receiving single lung transplantation for idiopathic pulmonary fibrosis, worsening of fibrosis of the native lung is usually progressive over time, with no significant effects on gas exchange. Case presentation Here, we describe the cases of two Caucasian male recipients of single lung transplants for idiopathic pulmonary fibrosis, 65 and 62 years of age, who exhibited acute worsening of lung fibrosis after an episode of serious viral infection (cytomegalovirus primo-infection in one case and COVID-19 in the other). In both cases, along with opacification of the native lung over several days, the patients presented acute respiratory failure that required the use of high-flow nasal oxygen therapy. Eventually, hypoxemic respiratory failure resolved, but with rapid progression of fibrosis of the native lung. Conclusion We conclude that acute worsening of fibrosis on the native lung secondary to a severe viral infection should be added to the list of potential complications developing on the native lung after single lung transplantation for idiopathic pulmonary fibrosis.

Native-lung complications following single-lung transplantation for interstitial lung disease: an in-depth analysis

“…Post-SLTx recipients are reliant on graft lung function, and even when complications occur in the native lung, symptoms are often minimal, making acute exacerbations in the native lung easy to overlook. Goletto et al reported cases of acute exacerbation in the native lung following infection with CMV and SARS-CoV-2 in two SLTx for IPF [ 23 ]. Despite progressive fibrosis in the native lung, infection in the graft improved, and the recipients were discharged safely.…”