Successful Lung Transplantation for Severe Post-COVID-19 Pulmonary Fibrosis

Abstract

Lung transplantation has been well described for patients with coronavirus disease 2019 (COVID-19) in the acute setting, but less so for the resulting pulmonary sequelae. This report describes a case of lung transplantation for post-COVID-19 pulmonary fibrosis. A 52-year-old woman contracted COVID-19 in July 2020 and mounted a partial recovery, but she went on to have declining function over the ensuing 3 months, with development of fibrocystic lung changes. She underwent bilateral lung transplantation and recovered rapidly, was discharged home on postoperative day 14, and has done well in follow-up. This case report demonstrates that lung transplantation is an acceptable therapy for post-COVID-19 pulmonary fibrosis.

Figure 1

Pretransplantation representative chest imaging demonstrating fibrotic changes in the bilateral upper lobes greater than in the lower lobes with some apical cystic change and traction bronchiectasis with mild bilateral hilar mediastinal lymphadenopathy.

Figure 2

Representative photomicrographs from pathologic examination of the explanted lungs. (A) Peripheral section of the lung showing the subpleural area with dense fibrosis and microscopic honeycombing (hematoxylin and eosin [H&E]; original magnification ×20). (B) Peripheral cystic spaces with giant cell reaction (H&E; original magnification ×100). (C) Lung parenchyma showing a nonspecific interstitial pneumonia–like pattern of fibrosis (H&E; original magnification ×40). (D) Sieve-like pattern of fibrosis in the central lung (H&E; original magnification ×40).