Coronavirus Disease 2019 Causing Infection of Transplanted Lung Allograft: A Pitfall of Prolonged Shedding of Severe Acute Respiratory Syndrome Coronavirus-2 Pretransplant

Mayo Clin Proc Innov Qual Outcomes. 2023 Apr;7(2):93-98. doi: 10.1016/j.mayocpiqo.2023.01.001. Epub 2023 Jan 10.

Abstract

Coronavirus disease 2019 (COVID-19) pandemic has led to considerable morbidity and mortality across the world. Lung transplant is a viable option for a few with COVID-19-related lung disease. Whom and when to transplant has been the major question impacting the transplant community given the novelty of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We describe a pitfall of presumed prolonged shedding of SARS-CoV-2 in a patient with COVID-19 associated acute respiratory distress syndrome leading to COVID-19 pneumonia after lung transplant. This raises concerns that replication-competent SARS-CoV-2 virus can persist for months post-infection and can lead to re-infection of grafts in the future.

Keywords: BAL, bronchoalveolar lavage; BSL-3, Biosafety level-3; COVID-19, coronavirus disease 2019; CP, convalescent plasma; CT, computed tomography; LT, lung transplant; NPS, nasopharyngeal swab; RT-PCR, reverse transcriptase–polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2; VV-ECMO, veno-venous extracorporeal membrane oxygenation.

Publication types

  • Case Reports