Bilateral lung transplantation during pregnancy after ECMO for influenza-A caused ARDS

Abstract

Pregnant women with influenza-A have an increased risk of developing acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) can be used as salvage therapy, with lung transplantation as a therapeutic option. However, successful bilateral lung transplantation during pregnancy has never been reported before. We herein report the case of a 34-year-old primipara, who was diagnosed with ARDS caused by influenza-A-induced pneumonia at early gestation. After considering all possible therapeutic options and being fully dependent on VV-ECMO support, she underwent bilateral lung transplantation. The transplantation with intraoperative central VA-ECMO support was successfully performed with good recovery after an initial primary graft dysfunction. The pregnancy was prolonged until 29⁺⁵ gestational weeks. The newborn exhibited growth retardation and was initially stabilized, but later died due to severe, hypoxic respiratory failure and pulmonary hypertension. In conclusion, lung transplantation is a possible salvage therapy for patients with severe lung failure following ARDS during pregnancy. However, it places the mother and unborn child at risk. A multi-professional approach is warranted to diagnose and treat complications at an early stage.

Keywords: clinical research/practice; extracorporeal membrane oxygenation (ECMO); lung disease: infectious; lung transplantation/pulmonology; obstetrics and gynecology; pregnancy.

FIGURE 1

CT scan of the maternal lungs at the time of listing for transplantation

FIGURE 2

Maternal chest X‐ray on postoperative day 3

FIGURE 3

Postmortem histopathologic examination of the fetal lungs. Persistent pulmonary hypertension characterized by peripheral extension of the smooth muscle and circumferential muscularization of the pulmonary arterioles (indicated by the *) [Color figure can be viewed at wileyonlinelibrary.com]