Lung Transplantation Following Paraquat Poisoning: Time to Think

Area of Science:

• Toxicology
• Transplantation Medicine
• Pulmonology

Background:

• Paraquat herbicide ingestion causes multi-organ damage, including lungs, kidneys, and liver.
• High mortality rates (up to 90%) are associated with severe paraquat poisoning.
• Lung transplantation is rarely reported and its timing and post-transplant concerns remain unclear.

Purpose of the Study:

• To evaluate the feasibility and outcomes of bilateral lung transplantation in patients with severe paraquat poisoning.
• To determine the necessary conditions and timing for paraquat depletion before lung transplantation.
• To assess the safety and efficacy of immunosuppression protocols post-transplant.

Main Methods:

• Case report of 2 patients with severe paraquat poisoning requiring extracorporeal membrane oxygenation, hemodialysis, and liver support.
• Monitoring of urine paraquat levels to confirm complete depletion before transplantation.
• Bilateral lung transplantation performed with basiliximab induction and triple immunosuppression.

Main Results:

• Both patients achieved negative urine paraquat levels after a median of 32 days.
• Successful bilateral lung transplantation was performed in both cases.
• Patients experienced successful outcomes post-transplantation, indicating the viability of the procedure.

Conclusions:

• Bilateral lung transplantation is a reasonable option for paraquat poisoning unresponsive to conventional treatments.
• Complete paraquat depletion and optimized renal/liver function are critical prerequisites for successful transplantation.
• This case series suggests that lung transplantation can lead to successful outcomes in select patients with paraquat toxicity.