Lung Transplantation as a way to Escape Pneumonia in Patients with COVID-19: Lessons from ARDS and Influenza

Reyhaneh Shams Khozani, Dorsa Shekouh, Sayyed Amirreza Hosseini, Mehrnush Saghab Torbati, Mahsa Noorian, Reyhaneh Rabiei, Qazal Mohseni, Hossein Rostami Rad, Shakiba Shaterzadeh Bojd, Parastoo Hosseini, Arina Ansari, Kimia Godazandeh, Niloofar Deravi


In this era, the novel Coronavirus, referred to as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), a life-threatening virus with a high mortality rate (4.2%) and with no absolute treatment as of yet, may ultimately result in acute respiratory distress syndrome (ARDS). ARDS is one of the fatal complications, highlighted by pulmonary infiltration and severe hypoxemia. This condition can be developed from primary lung inflammation caused by various viruses, particularly influenza viruses, some of the most common human pathogens. Due to this issue, many studies explored several approaches for ARDS treatment. Lung transplantation has been claimed as an efficient cure for severe ARDS and Influenza, which can also be offered for treating critical lung complications of SARS-CoV-2. Thereupon, to the best of our knowledge for the first time, we aimed to review all available data about capability of lung transplantation for the treatment of critically ill patients with ARDS, Influenza, and SARS-CoV-2.


SARS-CoV-2; COVID-19; ARDS; influenza; lung transplantation


Fauci AS, Lane HC, Redfield RR. COVID-19—navigating the uncharted. Mass Medical Soc. 2020.

Al Aklabi MM, Weinkauf JG, Humar A, Ghorpade N. Successful bilateral lung transplantation in a patient with end-stage lung disease and positive novel influenza virus (H1N1). J Heart Lung Transplant. 2010;29(8):898-9.

McCreary EK, Angus DC. Efficacy of Remdesivir in COVID-19. JAMA. 2020;324(11):1041-2.

Ben-Zvi I, Kivity S, Langevitz P, Shoenfeld Y. Hydroxychloroquine: from malaria to autoimmunity. Clin Rev Allergy Immunol. 2012;42(2):145-53.

Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic treatments for Coronavirus disease 2019 (COVID-19): a review. JAMA. 2020;323(18):1824-36.

Meyers BF, Lynch J, Trulock EP, Guthrie TJ, Cooper JD, Patterson GA. Lung transplantation: a decade of experience. Annals of Surgery. 1999;230(3):362.

Uhlin M, Mattsson J, Maeurer M. Update on viral infections in lung transplantation. Curr Opin Pulm Med. 2012;18(3):264-70.

Lang C, Jaksch P, Hoda MA, et al. Lung transplantation for COVID-19-associated acute respiratory distress syndrome in a PCR-positive patient. Lancet Respir Med. 2020;8(10):1057-60.

Cypel M, Keshavjee S. When to consider lung transplantation for COVID-19. Lancet Respir Med. 2020;8(10):944-6.

Chen JY, Qiao K, Liu F, et al. Lung transplantation as therapeutic option in acute respiratory distress syndrome for coronavirus disease 2019-related pulmonary fibrosis. Chin Med J (Engl). 2020;133(12):1390-6.

Luyt C-E, Combes A, Becquemin M-H, et al. Long-term outcomes of pandemic 2009 influenza A (H1N1)-associated severe ARDS. Chest. 2012;142(3):583-92.

Benazzo A, Schwarz S, Frommlet F, et al. Twenty-year experience with extracorporeal life support as bridge to lung transplantation. J Thoracic Cardiovasc Surg. 2019;157(6):2515-25. e10.

Hoetzenecker K, Donahoe L, Yeung JC, et al. Extracorporeal life support as a bridge to lung transplantation–experience of a high-volume transplant center. J Thoracic Cardiovasc Surg. 2018;155(3):1316-28. e1.

Weill D, Benden C, Corris PA, et al. A consensus document for the selection of lung transplant candidates: 2014--an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. J Heart Lung Transplant. 2015;34(1):1-15.

Doglietto F, Vezzoli M, Gheza F, et al. Factors associated with surgical mortality and complications among patients with and without Coronavirus disease 2019 (COVID-19) in Italy. JAMA Surgery. 2020.

Bittner HB, Lehmann S, Rastan A, et al. Outcome of extracorporeal membrane oxygenation as a bridge to lung transplantation and graft recovery. Annals Thoracic Surg. 2012;94(3):942-50.

Spagnolo P, Balestro E, Aliberti S, et al. Pulmonary fibrosis secondary to COVID-19: a call to arms? Lancet Respir Med. 2020.

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.

Remuzzi A, Remuzzi G. COVID-19 and Italy: what next? Lancet. 2020.

Arentz M, Yim E, Klaff L, et al. Characteristics and outcomes of 21 critically ill patients with COVID-19 in Washington State. JAMA. 2020;323(16):1612-4.

Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020.

Lyu H, Han W, Wang D, Liang T, Hu S. Perioperative mental evaluation and intervention for lung transplantation in elderly patients with COVID-19. Psychiatry Clin Neurosci. 2020;74(10):568-9.

Tabary M, Khanmohammadi S, Araghi F, Dadkhahfar S, Tavangar SM. Pathologic features of COVID-19: A concise review. Pathology-Research and Practice. 2020:153097.

Guan WJ, Ni ZY, Hu Y, et al. Clinical characteristics of Coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20.

Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in different types of clinical specimens. JAMA. 2020;323(18):1843-4.

Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with Coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43.

Dhochak N, Singhal T, Kabra SK, Lodha R. Pathophysiology of COVID-19: Why children fare better than adults? Indian J Pediatr. 2020;87(7):537-46.

Mehra MR, Canter CE, Hannan MM, et al. The 2016 International Society for Heart Lung Transplantation listing criteria for heart transplantation: A 10-year update. J Heart Lung Transplant. 2016;35(1):1-23.

Yusen RD, Edwards LB, Kucheryavaya AY, et al. The registry of the International Society for Heart and Lung Transplantation: Thirty-second Official Adult Lung and Heart-Lung Transplantation Report--2015; Focus Theme: Early Graft Failure. J Heart Lung Transplant. 2015;34(10):1264-77.

de Wit E, van Doremalen N, Falzarano D, Munster VJ. SARS and MERS: recent insights into emerging coronaviruses. Nat Rev Microbiol. 2016;14(8):523-34.

Han W, Zhu M, Chen J, et al. Lung transplantation for elderly patients with end-stage COVID-19 pneumonia. Ann Surg. 2020;272(1):e33-e4.

Bharat A, Querrey M, Markov NS, et al. Lung transplantation for pulmonary fibrosis secondary to severe COVID-19. medRxiv. 2020.

van der Mark SC, Hoek RAS, Hellemons ME. Developments in lung transplantation over the past decade. Eur Respir Rev. 2020;29(157).

Ranieri VM, Rubenfeld GD, Thompson BT, et al. Acute respiratory distress syndrome: the Berlin definition. JAMA. 2012;307(23):2526-33.

Quan C, Li C, Ma H, Li Y, Zhang H. Immunopathogenesis of Coronavirus-induced acute respiratory distress syndrome (ARDS): Potential infection-associated hemophagocytic lymphohistiocytosis. Clin Microbiol Rev. 2020;34(1).

Ragab D, Salah Eldin H, Taeimah M, Khattab R, Salem R. The COVID-19 cytokine storm; What we know so far. Front Immunol. 2020;11:1446.

Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet. 2020;395(10223):497-506.

Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-13.

Lai CC, Shih TP, Ko WC, Tang HJ, Hsueh PR. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges. Int J Antimicrob Agents. 2020;55(3):105924.

Cron RQ, Behrens EM. Cytokine storm syndrome. 2019.

Chang Y, Lee SO, Shim TS, et al. Lung Transplantation as a therapeutic option in acute respiratory distress syndrome. Transplantation. 2018;102(5):829-37.

Brichon PY, Barnoud D, Pison C, Perez I, Guignier M. Double lung transplantation for adult respiratory distress syndrome after recombinant interleukin 2. Chest. 1993;104(2):609-10.

Bates AR, Hanot J, Carroll A, Muhieldin A, Anton N, Lequier L. A pediatric case of prolonged extracorporeal support and successful lung transplantation following invasive pulmonary Aspergillosis and Influenza infection. D51 PEDIATRIC CASES II: American Thoracic Society; 2016. p. A7249-A.

Influenza WCotWCoCAoP. Clinical aspects of pandemic 2009 influenza A (H1N1) virus infection. New Engl J Med. 2010;362(18):1708-19.

Shieh W-J, Blau DM, Denison AM, et al. 2009 pandemic influenza A (H1N1): pathology and pathogenesis of 100 fatal cases in the United States. The American journal of pathology. 2010;177(1):166-75.

Weill D, Benden C, Corris PA, et al. A consensus document for the selection of lung transplant candidates: 2014—an update from the Pulmonary Transplantation Council of the International Society for Heart and Lung Transplantation. Elsevier; 2015.

Organization WH. Coronavirus disease (COVID-19): Similarities and differences with influenza 2020.

Lisa Lockerd Maragakis MD, M.P.H. Coronavirus Disease 2019 vs.the Flu 2020 [Available from:

Wang Q, Pan S, Zhang S, Shen G, Huang M, Wu M. Lung transplantation in pulmonary fibrosis secondary to Influenza A pneumonia. Annals Thoracic Surg. 2019;108(4):e233-e5.

Perez-Padilla R dlR-ZD, Ponce de Leon S, et al. Pneumonia and respiratory failure from swine-origin influenza A (H1N1) in Mexico. N Engl J Med. 2009;361:680-9.

Danziger-Isakov LA, Husain S, Mooney ML, Hannan MM. The novel 2009 H1N1 influenza virus pandemic: unique considerations for programs in cardiothoracic transplantation. J Heart Lung Transplant. 2009;28(12):1341-7.

Hajjar LA, Schout D, Galas FR, et al. Guidelines on management of human infection with the novel virus influenza A (H1N1)--a report from the Hospital das Clínicas of the University of São Paulo. Clinics (Sao Paulo). 2009;64(10):1015-24.

Mason DP, Murthy SC, Yun JJ, et al. Lung transplantation in a recipient with novel 2009 H1N1 influenza: lessons learned. Thorac Cardiovasc Surg. 2011;59(2):126-7.

Yin Z, Kang Z, Yang D, Ding S, Luo H, Xiao E. A comparison of clinical and chest CT findings in patients with Influenza A (H1N1) virus infection and Coronavirus disease (COVID-19). AJR Am J Roentgenol. 2020;215(5):1065-71.

Full Text: PDF


  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.