Lung Transplantation in COVID 19 ARDS - Short Term Outcomes

Introduction

COVID-19 associated severe acute respiratory syndrome rapidly progress to irreversible lung injury, multiple organ failure and death. Lung transplantation is considered as the rescue therapy for these patients. Herein, we reported a case series of two successful life-saving bilateral lung transplantations for COVID-19-associated respiratory failure.

Case Report

Case 1: A 69-year-old male was admitted for hypoxia and altered mental status. He was diagnosed with COVID-19 pneumonia by abnormal CT findings and positive PCR result. After receiving a course of dexamethasone, convalescent plasma, remdesivir and broad-spectrum antibiotics, he remained to be profoundly hypoxic, requiring non-invasive ventilation. Following two negative PCR results, he underwent bilateral lung transplantation on day 57. He was discharged to rehab unit on postoperative day 26. No desaturation was observed with the 6-min walk test on 30-day follow-up.

Case 2: A 63-year-old male was presented with cough, and dyspnea. He was hemodynamically stable, SpO2 was 94%, chest x-ray was normal and tested positive for COVID-19. He was discharged home with dexamethasone and bronchodilators. However, he presented back on day 6 with worsening dyspnea. He was admitted and received a course of dexamethasone, remdesivir, convalescent plasma and broad-spectrum antibiotics. Due to persistent hypoxic respiratory failure, the patient underwent bilateral orthotopic lung transplantation on day 68. His postoperative course was complicated by primary graft dysfunction stage 3 and required open tracheostomy. His condition gradually improved and decannulated. He is currently on room air and able to walk 30 ft using a roller walker.

Summary

SARS-CoV-2 recovery is characterized by post inflammatory fibrosis and multi organ dysfunction. Lung transplantation can be successfully performed in patients with final stage respiratory failure of COVID-19 related pulmonary fibrosis.