Lung transplantation in a patient with SARS-CoV-2 infection: a case report

The COVID19 pandemic had a major impact on solid organ transplantation, causing concerns about the possibility of donor-derived infection and the risk of severe infection in positive recipients resulting from immunosuppression. Since transplant recipients are known to be at an increased risk of severe SARS-CoV-2 infection, transplantation societies recommend deferring transplantation in recipients with active SARS-CoV-2 infection. Several centers however perform transplants also in SARS-CoV-2 positive recipients, although the available data in literature remain limited, and mostly restricted to kidney and liver transplants, to provide clear data on the safety of transplantation in recipients with ongoing SARS-CoV-2 infection. Only two cases of lung transplants in patients with a positive SARS-CoV-2 nasal swab at the time of transplantation were reported in the literature. Unlike our case, the positivity was limited to the molecular test, which showed high cycle-threshold (CT) value (30.9 and 39.2, respectively). Here, we present a case of a successful double-lung transplant performed in a patient with ongoing SARS-CoV-2 infection, evidenced by a positive molecular swab with a low CT value on the day of transplantation. The post-transplant course was regular with good lung function and the patient was extubated on post-operative day 3. The patient was treated with remdesivir and rapidly cleared SARS-CoV2 RNA from nasal swab without COVID-related complications. Despite immunosuppression the patient did not develop SARS-CoV2 pneumonia.