Lung re-transplantation for COVID-19 related respiratory failure: A case report

ABSTRACT

Objectives: We would like to report a case in which a COVID-19 patient who was transferred to our hospital due to a lack of medical resources due to the COVID-19 outbreak in Daegu, South Korea, on February, 2020, underwent double lung transplantation after 110 days with VV-ECMO support and performed double lung re-transplantation 865 days after lung transplantation. Method(s) ECMO was performed on a total of 69 patients with COVID-19-related acute circulatory/ respiratory failure from February 2020 to December 2022. Among them, 16 patients were registered for lung transplantation, and 5 out of 16 registered patients performed lung transplants. One in five people who performed lung transplantation performed retransplantation on the 865thday after transplantation. Result(s) A 52-year-old female patient was transferred to our hospital, and VV-ECMO was performed the next day. The double lung transplantation was performed 112 days after hospitalization and was discharged 238 days after surgery. 668 days after lung transplantation, home O2 was applied as bronchitis obliterans syndrome, and her lung function deteriorated rapidly later, and re-transplantation was decided. In the patient;s HLA test, HLA class I cPRA% was 32% and HLA class II cPRA% was 100%. Desensitization was performed six times plasmapheresis with administrating Botezomib and immunoglobulin, and then re-transplantation was performed on the 865th day after lung transplantation. The patient has maintained her daily life without any special complications other than the occurrence of central DI after surgery. The pathological findings of the lung previously transplanted to the patient were acute rejection (ISHLT grade A2), chronic airway rejection (ISHLT grade C1, B0), and chronic vascular rejection (ISHLT grade D1). Conclusion(s) The long term result of patients who performed lung transplantation with COVID 19 related respiratory failure is still unknown. Therefore, even patients who have undergone long-term VV-ECMO support due to COVID 19 related respiratory failure are expected to achieve good results if lung transplantation is needed by carefully approaching and treating with a multidisciplinary approach.