Feasibility of Single Lung Transplant for Post-COVID Fibrosis: A Case Report

Abstract

IntroductionPreviously we reported bilateral lung transplantation is the last treatment option for irrecoverable COVID ARDS and post-COVID fibrosis. Now we report our first single lung transplant (SLTx) for post-COVID fibrosis.Case ReportA 59-year-old, never-smoker, female, with history of obstructive sleep apnea, hypertension and hyperlipidemia, presented to an outside hospital with COVID-19, shortness of breath, and bilateral pulmonary infiltrates on chest X-ray (CXR) (Figure 1a). She was admitted to the intensive care unit, never requiring intubation, for an overall 40-day hospitalization. At discharge, she had shortness of breath with minimal activity and required continuous oxygen (O2) therapy.One year later she presented to our institution for an outpatient lung transplant evaluation for her post-COVID fibrosis. Her cardiac work up was unremarkable, with the absence of pulmonary hypertension on echocardiogram and right heart catheterization. Computed Tomography of her chest showed only significant fibrosis in the upper lobes with traction bronchiectasis and volume loss (Figure 1c). Her lung ventilation perfusion scan showed grossly normal perfusion to both lungs. Thus, she was listed for left, right, and bilateral lungs with a Lung Allocation Score of 42.After 39 days of listing, she underwent left SLTx. Final pathology of her explanted lung (Figure 1d) showed both uninvolved lung parenchyma and interstitial fibrosis and capillary congestion (Figure 1e). Post-operatively, her course was unremarkable and she was discharged home on POD 19. She was seen in clinic on POD 22 and doing well with no need for supplemental O2 and improving CXR (Figure 1b).SummarySLTx can be used to treat debilitating post-COVID lung fibrosis when there is the absence of severe lung damage and pulmonary hypertension. Considering SLTx in these patients is necessary to expand the donor pool of lungs for a population of patients that will continue to grow with the continued COVID-19 pandemic.