Postpartum bilateral lung transplantation in COVID-19 associated respiratory failure

Abstract

In critically ill patients with COVID-19, established therapies in the setting of respiratory failure include invasive mechanical ventilation and extracorporeal membrane oxygenation (ECMO). This case report describes a pregnant woman in her 30s who was hospitalised at 35 weeks gestation with moderate COVID-19 disease. Her condition worsened following delivery, and she required intubation, maximum ventilatory support and ECMO. Because of the severe and irreversible nature of her lung disease, she ultimately underwent bilateral lung transplantation. This case showcases lung transplantation as an alternative life-saving option for patients with severe COVID-19 associated respiratory failure refractory to ECMO and mechanical ventilation. Further studies are needed to develop a multidisciplinary approach for patient selection for transplantation within the context of COVID-19 and to assess long-term outcomes.

Keywords: Adult intensive care; COVID-19; Mechanical ventilation; Pneumonia (respiratory medicine); Transplantation.

Figure 1

Timeline of patient’s clinical course. ECMO, extracorporeal membrane oxygenation; HD, hospital day.

Figure 2

Chest imaging findings. (A) Near complete opacification of lungs with evidence of pulmonary oedema, infection and pleural effusions on chest X-ray, hospital day 22. (B) Diffuse patchy consolidative and ground glass opacities, multifocal pneumonia, severe parenchymal disease and cysts seen on chest CT, hospital day 35.

Figure 3

Gross and pathological findings. (A) Intraoperative findings of ruptured haemorrhagic native lung. Used with permission of Dr Daizo Tanaka. (B) End stage changes of fibrotic lung. (C, D) Evidence of focal necrotic debris and pulmonary hypertension on pathology, H&E stain 2 x (C) and 4 x (D).

Figure 4

Postoperative chest imaging findings. Mild strand-like opacities of bilateral lungs.