SARS-CoV-2-Exposed Donor Lungs Transplanted Successfully

By Anne Harding

December 15, 2020

NEW YORK (Reuters Health) - A team from Belgium has reported a successful double-lung transplant from a donor previously infected with SARS-CoV-2.

Dr. Laurens J. Ceulemans of University Hospitals Leuven and colleagues describe the case, in which a 61-year-old woman with end-stage chronic obstructive pulmonary disease received the organs from a 72-year-old woman with hypertensive cerebral hemorrhage, in The Lancet Respiratory Medicine.

"The bottom line is it's a message of hope in these hard times of COVID 19," Dr. Ceulemans told Reuters Health by phone.

The donor had developed fever, cough, weakness and myalgia in April, three weeks after the epidemic began in Belgium. She didn't undergo SARS-CoV-2 screening due to lack of testing capacity. While she was isolating with her husband, he became ill and died from PCR-confirmed COVID-19.

The woman was hospitalized for intracranial bleeding in July. She was negative for SARS-CoV-2 on pharyngeal swab testing, but serology found SARS-CoV-2 IgG antibodies. Before donation, the woman tested negative again for SARS-CoV-2 by nasopharyngeal swab, and lower lobe bronchoalveolar lavage samples were also negative for the virus. Chest CT found no pulmonary infiltrates or interstitial lung disease.

The authors biopsied the right upper and left lower lobes of the donor lungs and found no fibrosis or injury due to COVID-19. There were low levels of SARS-CoV-2 RNA in the right lung, but viral culture was negative.

The recipient was discharged from the hospital six days after transplant. She developed minimal acute rejection and pneumothorax from a dislocated chest tube on days 15 and 24 after transplant, respectively, and both were treated successfully. She was discharged on day 35.

Bronchoalveolar lavage samples from the recipient were tested with SARS-CoV-2 PCR and viral culture at 15 days, 34 days and 90 days, and all were negative. Chest CT 14, 24 and 90 days after surgery found no lung injury, and the patient had normal spirometry at day 90.

The news that a person's lungs can heal well enough after COVID to be transplanted was hopeful for people in Belgium struggling with the pandemic, Dr. Ceulemans said. "Some of these patients, on the other hand, they will need some lungs themselves a few years from now," he added.

"We will be challenged by the virus over the next years and we always have to keep it in mind," Dr. Ceulemans said. "I think we will always need to invest a lot of time and effort in screening any potential lung donor."

SOURCE: Lancet Respiratory Medicine, online December 1, 2020.