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.

中文翻译：

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SARS-CoV-2 诱导的 ARDS 并发严重抗体介导的排斥反应，在 ECMO 支持下进行 6 个月的肺移植

有一些关于 SARS-CoV-2 引起的急性呼吸窘迫综合征 (ARDS) 患者成功肺移植 (LTx) 的报告；然而，所有报告的后续行动都相当短暂。在这里，我们介绍了一位 62 岁的男性，之前没有肺部疾病。在 SARS-CoV-2 引起的 ARDS 和 6 个月的体外膜肺氧合之后，他接受了 LTx。移植后 3 个月，他出现急性缺氧，需要紧急插管。胸部影像学显示急性排斥反应，并发现了 de novo DQ8-DSA。他接受了高剂量皮质类固醇和血浆置换治疗，4 天后拔管，但新生 DQ8-DSA 仍然存在。血浆置换和利妥昔单抗治疗后，从头 DQ8-DSA 的水平保持不变。移植后九个月，患者死于呼吸衰竭。我们在此讨论移植的决定、移植本身和术后严重的抗体介导排斥反应过程。此外，我们评估了移植肺的组织学变化，并将这些变化与终末期特发性肺纤维化组织进行了比较，其中既有相似之处，也有不同之处。根据目前的案例经验，人们可能会考虑密切监测 DSA，并进一步支持 LTx 应仅用于非常仔细挑选的患者。