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.

Keywords: acute lung injury; covid-19; lung fibrosis; lung transplant; respiratory failure.

Figure 1. CT scan of the chest without contrast

CT scan of the chest without contrast (axial image) shows extensive pneumomediastinum and small right pneumothorax. Pneumatocele (yellow arrow), mild bronchiectasis, ground-glass opacities, and consolidations in bilateral lower lobes can be seen.

Figure 2. CT scan of the chest with contrast (coronal image) shows bronchiectasis involving predominantly lower lobes, reticular interstitial opacities, pneumatocele (yellow arrow), and upper lobe airspace opacities

Figure 3. CT scan of the chest with contrast (axial image) shows traction bronchiectasis (yellow arrow) and subpleural reticulations (red arrowhead) in the right lung base that is suggestive of progressive fibrosis

Figure 4. Timeline of clinical events

BiPAP: bilevel positive airway pressure, CRRT: continuous renal replacement therapy, DVT: deep vein thrombosis, ECMO: extracorporeal membrane oxygenation, IVC: inferior vena cava, PCR: polymerase chain reaction, SARS: severe acute respiratory syndrome.