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Lung transplant after 6 months on ECMO support for SARS-CoV-2-induced ARDS complicated by severe antibody-mediated rejection

Lindstedt, Sandra LU ; Grins, Edgar LU orcid ; Larsson, Hillevi LU ; Nilsson, Johan LU orcid ; Akbarshahi, Hamid LU ; Silva, Iran LU orcid ; Hyllen, Snejana LU ; Wagner, Darcy LU orcid ; Sjögren, Johan LU and Hansson, Lennart LU , et al. (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.

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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
  • pmid:34544734
  • scopus:85115809059
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
2024-06-15 16:54:50
@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}},
}