Gonuguntla Hari Kishan, Tripathi Somesh, Varghese Vimi, Goda Sricharan, Vaddepally Chetan Rao, Kavumkal Rajagopalan Balasubramoniam, Kumar M Sheetal, Vidyasagar Belgundi Preeti
Department of Interventional Pulmonology Yashoda Hospitals Hyderabad India.
Department of Heart and Lung Transplant Yashoda Hospitals Hyderabad India.
Respirol Case Rep. 2025 Aug 27;13(8):e70324. doi: 10.1002/rcr2.70324. eCollection 2025 Aug.
Paraquat, a commonly available herbicide, when consumed in high doses, affects organs with high blood flow (lungs, heart, kidney and liver), leading to pulmonary fibrosis, respiratory failure and death. Few reports of rescue lung transplantation exist. Complete depletion of paraquat from the body is necessary prior to transplant; however, timing for and concerns after lung transplantation remain unknown. We report 2 patients (median age 19 years) with severe respiratory failure requiring extracorporeal membrane oxygenation support, acute kidney injury requiring haemodialysis and acute liver injury in the pre-transplant period. Volume of paraquat consumption was more than 30 mL and PF ratio less than 100 before transplant. Once their urine paraquat level was negative (median time 32 days), both underwent bilateral lung transplantation after receiving an induction agent with basiliximab and were continued on triple immunosuppressant following the transplant. With reported mortality rates reaching up to 90%, ung transplantation remains a reasonable option for patients with paraquat poisoning not responding to conventional treatment options. Once paraquat levels are negative and after optimising renal and liver function, these patients could be considered for bilateral lung transplantation and have successful outcomes as reported here.
百草枯是一种常见的除草剂，高剂量摄入时会影响血流丰富的器官（肺、心脏、肾脏和肝脏），导致肺纤维化、呼吸衰竭和死亡。关于挽救性肺移植的报道很少。移植前必须使体内百草枯完全清除；然而，肺移植的时机和术后问题仍不明确。我们报告了2例患者（中位年龄19岁），在移植前期出现严重呼吸衰竭需要体外膜肺氧合支持、急性肾损伤需要血液透析以及急性肝损伤。移植前百草枯摄入量超过30 mL且氧合指数低于100。一旦他们的尿百草枯水平呈阴性（中位时间32天），两人在接受巴利昔单抗诱导治疗后均接受了双侧肺移植，并在移植后继续使用三联免疫抑制剂。鉴于报道的死亡率高达90%，对于对传统治疗方法无反应的百草枯中毒患者，肺移植仍是一个合理的选择。一旦百草枯水平呈阴性且在优化肾和肝功能后，这些患者可考虑进行双侧肺移植，并能取得如本文所报道的成功结果。
