Kuo YS, Lin KH, Chen YY, Tsai YM, Wu TH, Huang HK, Huang TW. Success of intravenous immunoglobulin and steroids in managing severe COVID-19 following lung transplantation: A case report. World J Transplant 2025; 15(1): 96696 [DOI: 10.5500/wjt.v15.i1.96696]
Corresponding Author of This Article
Tsai-Wang Huang, MD, PhD, Professor, Surgeon, Surgical Oncologist, Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325 Section 2, Chenggong Rd, Neihu District, Taipei 114202, Taiwan. chi-wang@yahoo.com.tw
Research Domain of This Article
Transplantation
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Yen-Shou Kuo, Kuan-Hsun Lin, Ying-Yi Chen, Yuan-Ming Tsai, Ti-Hui Wu, Hsu-Kai Huang, Tsai-Wang Huang, Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei 114202, Taiwan
Author contributions: Kuo YS wrote the manuscript; Kuo YS, Lin KH, Chen YY, Tsai YM, and Wu TH attended the postoperative care; Kuo YS and Huang HK performed the donor-lung graft harvest surgery; Kuo YS and Huang TW performed the sequential double lung transplantation in this case; All authors have read and approved the final manuscript.
Informed consent statement: After obtaining approval from the Institutional Review Board (IRB) at Tri-Service General Hospital, the study (IRB number: C202415028) was conducted in accordance with the approved protocol. The IRB approval process ensures that the study adheres to ethical guidelines and protects the rights and welfare of human subjects. The study participant provided informed consent before enrollment, and all data collected were kept confidential and handled in accordance with data protection regulations.
Conflict-of-interest statement: All authors declare that there are no conflict of interests.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tsai-Wang Huang, MD, PhD, Professor, Surgeon, Surgical Oncologist, Division of Thoracic Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, No. 325 Section 2, Chenggong Rd, Neihu District, Taipei 114202, Taiwan. chi-wang@yahoo.com.tw
Received: May 14, 2024 Revised: October 2, 2024 Accepted: October 15, 2024 Published online: March 18, 2025 Processing time: 197 Days and 5.6 Hours
Abstract
BACKGROUND
Coronavirus disease 2019 (COVID-19) pneumonia with severe septic shock and acute respiratory distress syndrome (ARDS) are critical illnesses for patients following transplant. Intravenous immunoglobulin (IVIG) plays a role in both immune support and inflammation control, especially in immunocompromised patients. This case report describes the first successful experience using IVIG and pulse steroids to manage this critical condition following lung transplantation.
CASE SUMMARY
A 65-year-old male patient reported a history of chronic obstructive pulmonary disease and poor lung function and received bilateral sequential lung transplantations. Postoperatively, he developed COVID-19 pneumonia, severe septic shock, and ARDS. He recovered from this critical condition after empirical antibiotics administration and veno-venous extracorporeal membrane oxygenation, in addition to IVIG and pulse steroids.
CONCLUSION
IVIG is a valuable adjunct in managing severe sepsis in lung transplant recipients after COVID-19 infection. We aim, for the first time, to report the success of such a management approach for COVID-19 ARDS and sepsis in the post-lung transplant setting. With further investigations, this is a starting point for wider analysis of such an approach in this setting and consequently helps guide clinical practice for such a challenging patient population moving forward.
Core Tip: The first successful experience indicated intravenous immunoglobulin as a valuable adjunct in managing severe coronavirus disease 2019 infection complicated with severe acute respiratory distress syndrome and septic shock in a lung transplant recipient.
