Lung Transplantation Following Paraquat Poisoning: Time to Think

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%, lung 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.