Korean J Crit Care Med.  2015 Aug;30(3):196-201. 10.4266/kjccm.2015.30.3.196.

Lung Transplantation in Acute Respiratory Distress Syndrome Caused by Influenza Pneumonia

Affiliations
  • 1Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea.
  • 2Department of Infectious Disease, Asan Medical Center, College of Medicine University of Ulsan, Seoul, Korea.
  • 3Department of Pulmonary and Critical Care Medicine, Asan Medical Center, College of Medicine University of Ulsan, Seoul, Korea. sbhong@amc.seoul.kr
  • 4Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, College of Medicine University of Ulsan, Seoul, Korea.

Abstract

Severe acute respiratory distress syndrome (ARDS) is a life-threatening disease with a high mortality rate. Although many therapeutic trials have been performed for improving the mortality of severe ARDS, limited strategies have demonstrated better outcomes. Recently, advanced rescue therapies such as extracorporeal membrane oxygenation (ECMO) made it possible to consider lung transplantation (LTPL) in patients with ARDS, but data is insufficient. We report a 62-year-old man who underwent LTPL due to ARDS with no underlying lung disease. He was admitted to the hospital due to influenza A pneumonia-induced ARDS. Although he was supported by ECMO, he progressively deteriorated. We judged that his lungs were irreversibly damaged and decided he needed to undergo LTPL. Finally, bilateral sequential double-lung transplantation was successfully performed. He has since been alive for three years. Conclusively, we demonstrate that LTPL can be a therapeutic option in patients with severe ARDS refractory to conventional therapies.

Keyword

extracorporeal membrane oxygenation; influenza, human; lung transplantation; respiratory distress syndrome, adult

MeSH Terms

Extracorporeal Membrane Oxygenation
Humans
Influenza, Human*
Lung Diseases
Lung Transplantation*
Lung*
Middle Aged
Mortality
Pneumonia*
Respiratory Distress Syndrome, Adult*

Figure

  • Fig. 1. His chest radiography shows bilateral diffuse infiltration at admission (A). His initial chest computed tomography also shows diffuse ground glass opacity in both lungs (B).

  • Fig. 2. On hospital day 17, he underwent venous-venous extracorporeal membrane oxygenation.

  • Fig. 3. His normal chest radiograph one year after lung transplantation.

  • Fig. 4. The pathology of his explanted lungs showed end-stage lung disease with ring fibrosis and multifocal microscopic honeycomb change consistent with fibrotic phase of diffuse alveolar damage.


Reference

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