key: cord-0819495-ubbw8eat
authors: Kim, Hye-Jin; Shin, Dong Hoon; Cho, Woo Hyun; Kim, Dohyung; Yeo, Hye Ju
title: Successful lung transplantation from a donor who had recovered from SARS-CoV-2 pneumonia
date: 2021-07-20
journal: Ann Thorac Surg
DOI: 10.1016/j.athoracsur.2021.06.045
sha: fb86c18216023ef5aa8c2b571a10bfb6362e6162
doc_id: 819495
cord_uid: ubbw8eat

During the present COVID-19 pandemic, transplantation of donor lungs with a history of COVID-19 infection is a critical issue. Donor-derived virus infection and graft dysfunction are possible after transplantation. However, use of such lungs could save the lives of patients requiring emergency transplantation. We successfully transplanted lungs from a brain-dead donor who had recovered from SARS-CoV-2 into a severe respiratory failure patient supported with ECMO who needed an emergency transplant. At the 3-month follow-up, our patient showed no evidence of COVID-19 transmission or graft dysfunction.

As the COVID-19 pandemic continues, many potential organ donors are at risk of infection 1 .

In particular, lung transplantation faces critical challenges in terms of donor-derived infection and graft dysfunction. Unfortunately, it is not possible to wait for an optimal brain-dead donor; patients waiting for lung transplants are at high risk for mortality because of donor shortage.

Therefore, acceptance of a donor must be carefully determined according to the recipient's condition. To date, one case of lung transplantation from a previously COVID-19-infected donor has been reported, but an extracorporeal membrane oxygenation (ECMO) bridge was not used prior to transplantation 2 . We successfully transplanted lungs from a brain-dead donor who had recovered from SARS-CoV-2 pneumonia into a patient supported with ECMO who required an emergency transplant.

A 56-year-old woman with end-stage pleuroparenchymal fibroelastosis underwent venoarterial (VA) ECMO because of consistently high pulmonary hypertension combined with right heart failure (maximal tricuspid regurgitation velocity 3.7 m/s). She had been on home oxygen therapy for 2 years while waiting for a lung transplant. Fortunately, a brain-dead donor was allocated to her on day 2 of ECMO. The donor was a 66-year-old woman who suffered brain death from a traumatic subarachnoid hemorrhage. Three months previously, she had been hospitalized with pneumonia, and PCR confirmed COVID-19 infection (figure 1). After 10 days of conservative treatment, she was PCR-negative and was discharged home. One month later, the pneumonia had completely resolved and she remained PCR-negative. Two months later, she was admitted with a traumatic subarachnoid hemorrhage; a nasopharyngeal swab and bronchoalveolar lavage fluid were PCR-negative for SARS-CoV-2. Liver and lung functions were normal, but kidney function was lost, requiring continuous renal replacement therapy.

After 6 days, she was diagnosed with brain death (she was EEG-negative) and her organs were can cause acute lung injury, but the long-term lung effects remain unknown 5 . Even after the pneumonia resolves, alveolar damage, irreversible lung fibrosis, and respiratory dysfunction may remain. Therefore, careful CT and blood gas analysis are required. The ISHLT states that donor lungs from patients who have recovered from COVID-19 are acceptable if at least 28 days have passed from symptom onset, two PCR tests are negative, and no permanent organ damage is detected. In our case, the donor had been infected with SARS-Cov-2 at 3 months before and had recovered after 1 month. SARS-CoV-2 PCR tests of the upper and lower respiratory tracts were repeatedly negative, as was the lung biopsy sample. Thus, the risk of donor-derived SARS-CoV-2 transmission was very low.

In conclusion, we safely placed lungs from a donor who had recovered from COVID-19 pneumonia in a severe respiratory failure patient supported with ECMO. Before transplantation, repeated upper and lower respiratory tract tests were negative for SARS-CoV-2 and chest CT revealed no residual lung injury. The lungs were successfully transplanted; there was no viral transmission or other complication. Although the follow-up period was short, this was the only option to save her life. Further studies are required to determine long-term safety and effectiveness. Acceptance of a donor with a COVID-19 history must depend on the recipient's condition.

J o u r n a l P r e -p r o o f 

Donor to recipient transmission of SARS

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

Successful double-lung transplantation from a donor previously infected with SARS-CoV-2. The Lancet Respiratory medicine 2021

Guidance from the International Society of Heart and Lung Transplantation regarding the SARS CoV-2 pandemic

SARS-CoV-2 vaccines in development

Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the