Lung Transplantation in a Patient With COVID-19-Associated Acute Respiratory Failure

Abstract

Coronavirus disease 2019 (COVID-19) is currently a significant cause of acute respiratory failure worldwide, leading to irreversible fibrotic lung disease. In patients with persistent respiratory failure after acute COVID-19 infection, lung transplant is an emerging option. Here, we have presented a case where the patient required venovenous extracorporeal membrane oxygenation (VV-ECMO) support for 33 days until a bilateral lung transplant was performed on day 71 after the initial COVID-19 infection. The early outcomes have been favorable. Currently, no guidelines exist for an acceptable time period after initial COVID-19 infection, duration of negative COVID polymerase chain reaction (PCR) testing, or negative Vero cell culture in the setting of persistent positive COVID PCR testing before listing for a lung transplant. Due to a lack of standardized guidelines, this patient was not listed for a lung transplant until the COVID-19 PCRs came negative on days 47 and 49 after the infection.

Ethical dilemmas in COVID-19 patients awaiting lung transplantation on extracorporeal membrane oxygenation

“…First, there was a signi cant collapse in terms of available organs around the world during the COVID-19 pandemic [18,19] and Poland was no exception in this regard [9,19,20]. Second, due to the upward shift of the diapharm in patients with COVID-19, there is rapidly progressive brosis and a loss of tidal volumes, which makes it extremely di cult to nd suitable donors for LT [2,10,21]. In these particular cases, only short stature donors (or older pediatric donors) may be considered, as downsizing of donor lungs is technically very demanding [21].…”

“…Second, due to the upward shift of the diapharm in patients with COVID-19, there is rapidly progressive brosis and a loss of tidal volumes, which makes it extremely di cult to nd suitable donors for LT [2,10,21]. In these particular cases, only short stature donors (or older pediatric donors) may be considered, as downsizing of donor lungs is technically very demanding [21]. Third, choosing the right recipient is very challenging.…”

Lung Transplantation for COVID-19–related Lung Disease: Clinical Experience and Call for a Global Registry

“…Most of the early available case reports only document short-term posttransplant outcomes on single patients or case series. 7,8,11,[16][17][18] Very recently, analyses of larger patient cohorts over a longer time span have been published: A retrospective analysis of the United Network of Organ Sharing database reported outcomes on 214 patients who received lung transplantation for COVID-19-related respiratory failure in the United States 2 with a median followup of 1.9 mo. Patients were relatively young (mean age 52 y) and predominantly male (79.2%)‚ and included a high percentage of patients of Hispanic origin (36.6%), consistent with reports that have identified a higher risk of COVID-19-related respiratory failure in this group.…”

“… 16 Secondary colonization or infection with bacterial or fungal organisms is a common complication of prolonged critical illness, mechanical ventilation, and pleural instrumentation. It is largely unclear how this affects posttransplant outcomes, although some cases of postoperative morbidity and mortality related to bacterial 17 and fungal sepsis 16 have been reported.…”