Lung Transplantation for End-Stage Respiratory Failure After Severe COVID-19: A Report of 2 Cases

Abstract

We report two cases of bilateral lung transplantation (LTx) for non-resolving COVID-19 associated respiratory failure. In the first patient, the SARS CoV-2 infection caused acute respiratory distress syndrome (ARDS) requiring prolonged ECMO support, while in the second patient, COVID-19 resulted in irreversible pulmonary fibrosis requiring only ventilatory support. The two cases represent the two ends of the spectrum showing significant differences in preoperative and postoperative courses.

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

“…The timing of transplant in patients with COVID-19–related ARDS is highly challenging and has varied from 41 d 7 to 6 mo 8 from the time of diagnosis in the published literature. The potential for delayed recovery has to be weighed against the risk of complications from prolonged critical illness.…”

“…Limited data suggest that patients with CRLD who are unable to consent may be more prone to posttransplant depression, especially in cases of a prolonged and difficult recovery. 7 Noncompliance may complicate the posttransplant course, especially in patients without prior medical history and need for long-term follow-ups.…”

“…Most of the early available case reports only document short-term posttransplant outcomes on single patients or case series. 7 , 8 , 11 , 16 - 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 follow-up 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.…”