Lung transplant after 6 months on ECMO support for SARS-CoV-2-induced ARDS complicated by severe antibody-mediated rejection
(2021) In BMJ Open Respiratory Research 8. p.1-4- Abstract
There have been a few reports of successful lung transplantation (LTx) in patients with SARS-CoV-2-induced acute respiratory distress syndrome (ARDS); however, all reports were with rather short follow-up. Here we present a 62-year-old man without prior lung diseases. Following SARS-CoV-2-induced ARDS and 6 months of extracorporeal membrane oxygenation, he underwent LTx. 3 months post-transplantation he developed acute hypoxia requiring emergency intubation. Chest imaging showed acute rejection, and de novo DQ8-DSA was discovered. He was treated with a high dose of corticosteroids and plasmapheresis and was extubated 4 days later, yet the de novo DQ8-DSA remained. After sessions of plasmapheresis and rituximab, the levels of de novo... (More)
There have been a few reports of successful lung transplantation (LTx) in patients with SARS-CoV-2-induced acute respiratory distress syndrome (ARDS); however, all reports were with rather short follow-up. Here we present a 62-year-old man without prior lung diseases. Following SARS-CoV-2-induced ARDS and 6 months of extracorporeal membrane oxygenation, he underwent LTx. 3 months post-transplantation he developed acute hypoxia requiring emergency intubation. Chest imaging showed acute rejection, and de novo DQ8-DSA was discovered. He was treated with a high dose of corticosteroids and plasmapheresis and was extubated 4 days later, yet the de novo DQ8-DSA remained. After sessions of plasmapheresis and rituximab, the levels of de novo DQ8-DSA remained unchanged. Nine months post-transplantation the patient died of respiratory failure. We herein discuss the decision to transplant, the transplantation itself and the postoperative course with severe antibody-mediated rejection. In addition, we evaluated the histological changes of the explanted lungs and compared these with end-stage idiopathic pulmonary fibrosis tissue, where both similarities and differences are seen. With the current case experience, one might consider close monitoring regarding DSA, and gives further support that LTx should only be considered for very carefully selected patients.
(Less)
- author
- organization
-
- Clinical and experimental lung transplantation (research group)
- WCMM-Wallenberg Centre for Molecular Medicine
- Cardiothoracic anesthesia and intensive care (research group)
- Less invasive cardiac surgery (research group)
- Anesthesiology and Intensive Care
- Thoracic Surgery
- Artificial Intelligence and Bioinformatics in Cardiothoracic Sciences (AIBCTS) (research group)
- Heart and Lung transplantation (research group)
- Respiratory Medicine, Allergology, and Palliative Medicine
- Translational Respiratory Medicine (research group)
- EpiHealth: Epidemiology for Health
- Respiratory Immunopharmacology (research group)
- StemTherapy: National Initiative on Stem Cells for Regenerative Therapy
- Lung Bioengineering and Regeneration (research group)
- Bleeding disorders and acute typ-A dissection (research group)
- Minimal invasive cardiac surgery in valvular heart disease (research group)
- publishing date
- 2021
- type
- Contribution to journal
- publication status
- published
- subject
- in
- BMJ Open Respiratory Research
- volume
- 8
- article number
- e001036
- pages
- 1 - 4
- publisher
- BMJ Publishing Group
- external identifiers
-
- scopus:85115809059
- pmid:34544734
- ISSN
- 2052-4439
- DOI
- 10.1136/bmjresp-2021-001036
- language
- English
- LU publication?
- yes
- id
- 8d513b60-2fcf-416d-8867-1cfbbbd37aed
- date added to LUP
- 2021-09-27 09:39:03
- date last changed
- 2024-06-29 17:59:06
@article{8d513b60-2fcf-416d-8867-1cfbbbd37aed, abstract = {{<p>There have been a few reports of successful lung transplantation (LTx) in patients with SARS-CoV-2-induced acute respiratory distress syndrome (ARDS); however, all reports were with rather short follow-up. Here we present a 62-year-old man without prior lung diseases. Following SARS-CoV-2-induced ARDS and 6 months of extracorporeal membrane oxygenation, he underwent LTx. 3 months post-transplantation he developed acute hypoxia requiring emergency intubation. Chest imaging showed acute rejection, and de novo DQ8-DSA was discovered. He was treated with a high dose of corticosteroids and plasmapheresis and was extubated 4 days later, yet the de novo DQ8-DSA remained. After sessions of plasmapheresis and rituximab, the levels of de novo DQ8-DSA remained unchanged. Nine months post-transplantation the patient died of respiratory failure. We herein discuss the decision to transplant, the transplantation itself and the postoperative course with severe antibody-mediated rejection. In addition, we evaluated the histological changes of the explanted lungs and compared these with end-stage idiopathic pulmonary fibrosis tissue, where both similarities and differences are seen. With the current case experience, one might consider close monitoring regarding DSA, and gives further support that LTx should only be considered for very carefully selected patients.</p>}}, author = {{Lindstedt, Sandra and Grins, Edgar and Larsson, Hillevi and Nilsson, Johan and Akbarshahi, Hamid and Silva, Iran and Hyllen, Snejana and Wagner, Darcy and Sjögren, Johan and Hansson, Lennart and Ederoth, Per and Gustafsson, Ronny}}, issn = {{2052-4439}}, language = {{eng}}, pages = {{1--4}}, publisher = {{BMJ Publishing Group}}, series = {{BMJ Open Respiratory Research}}, title = {{Lung transplant after 6 months on ECMO support for SARS-CoV-2-induced ARDS complicated by severe antibody-mediated rejection}}, url = {{http://dx.doi.org/10.1136/bmjresp-2021-001036}}, doi = {{10.1136/bmjresp-2021-001036}}, volume = {{8}}, year = {{2021}}, }