key: cord-1015073-djds5aqe
authors: Mercier, Olaf; Laverdure, Florent; Filaire, Laura; Mal, Hervé; Bunel, Vincent; Deblauwe, Delphine; Wemeau, Lidwine; Dauriat, Gaëlle; Fadel, Elie; Vincentelli, André
title: Fatal Covid‐19 vasoplegic shock in a recipient few hours before double lung transplantation in high emergency
date: 2020-08-12
journal: Transpl Infect Dis
DOI: 10.1111/tid.13445
sha: 179123588ad71681c7e6ea8c904fa27e8658f4be
doc_id: 1015073
cord_uid: djds5aqe

SARS‐Cov2 outbreak has deeply impacted French lung transplant programs by the decreased number of lung donors, the scarcity of intensive care unit (ICU) beds and most importantly, the assumed worse prognosis of Covid‐19 in recipients during perioperative period. Despite no evidence has been published to suggest that lung transplant recipients were at high‐risk of acquiring the virus or developing severe Covid‐19, immunosuppression may worsen the prognosis of such infection in patient transplanted for end‐staged lung diseases.

This article is protected by copyright. All rights reserved SARS-Cov2 outbreak has deeply impacted French lung transplant programs by the decreased number of lung donors, the scarcity of intensive care unit (ICU) beds and most importantly, the assumed worse prognosis of Covid-19 in recipients during perioperative period.

Despite no evidence has been published to suggest that lung transplant recipients were at highrisk of acquiring the virus or developing severe Covid-19, immunosuppression may worsen the prognosis of such infection in patient transplanted for end-staged lung diseases.

We present the case of a 59 year-old patient with pulmonary fibrosis who has been listed for lung transplantation (LTx) in March 2020. Two weeks after listing, the patient presented with severe respiratory compromise without fever. Chest CT did not show signs of SARS-Cov2 pneumonia. Nasal, tracheal and rectal SARS-Cov2 PCR were repeated three times daily before Our case demonstrated the severity of COVID-19 clinical worsening in Phase I disease 1 when nasal swab PCR is positive. It seems mandatory to benefit from recipient SARS Cov2 PCR results as close as possible to acceptance of donor lungs for transplantation. Considering the time needed to run SARS-Cov2 test, improved transplant logistic management, including ex-vivo lung perfusion 2 , simultaneous recipients call, rapid SARS-Cov2 testing pathway or pooling recipients between LTx centers, will be undoubtly useful during COVID-19 period. For our deteriorating patient, repeated routine testing would have been a solution to make a prompter

This article is protected by copyright. All rights reserved diagnosis and better adapt medical management. Obtaining lower respiratory tract specimens such as tracheal aspirates in line with infection control precautions should be considered for intubated patients 3 . Additionally, one should emphasize that COVID-19 symptoms may have overlapped fibrosis worsening symptoms and delayed COVID-19 diagnosis. Chest CT would have been an additional valuable diagnostic tool 4 provided baseline images are available. Indeed, it may be challenging to differentiate lung disease from COVID-19 induced lesions 5 . It is likely that our patient may have contracted the disease during his hospital stay. Asymptomatic SARS-Cov2 carriers 6 may be a source of virus spreading among health workers and patients. Maintaining containment, developing solutions to monitor COVID-19 contacts and routine screening are questions that should be discussed and regularly reassessed for listed outpatients. At least, we showed that solidarity between LTx programs was feasible and effective.

COVID-19 Illness in Native and Immunosuppressed States: A Clinical-Therapeutic Staging Proposal

Logistic ex Vivo Lung Perfusion for Hyperimmunized Patients

Detection of SARS-CoV-2 in Different Types of Clinical Specimens

Sensitivity of Chest CT for COVID-19: Comparison to RT-PCR

Clinical course of coronavirus disease 2019 in 11 patients after thoracic surgery and challenges in diagnosis

Presumed Asymptomatic Carrier Transmission of COVID-19

This article is protected by copyright. All rights reserved