Evaluation of the use of Lung transplantation in acute paraquat poisoning: A Review Study

Abstract

Background: Acute paraquat poisoning remains a critical therapeutic challenge with high mortality, primarily due to irreversible pulmonary fibrosis. Lung transplantation (LT) maybe is the only definitive life-saving option for these patients. This systematic review aimed to investigate the factors associated with survival outcomes in patients who underwent LT following paraquat poisoning. Methods: This was a retrospective analysis of 12 reported cases from 1968 to 2025, identified through a comprehensive search of major international databases. The collected demographic, clinical, and outcome data were analyzed using statistical tests such as chi-square for categorical variables and t-test or Mann-Whitney U for continuous variables. Results: Among the analyzed patients, 9 (75) survived, and 3 died. The analysis revealed a significant association between preoperative liver function (p=0.03) and the type of lung transplantation (p=0.025) with survival. A 100 survival rate was observed in patients with recovered liver function and in all patients, who received a bilateral LT. Furthermore, a significantly shorter time from poisoning to both ECMO initiation and LT was associated with higher mortality (p=0.025 and p=0.009, respectively). Conclusion: Lung transplantation is an effective treatment for paraquat poisoning with irreversible pulmonary fibrosis. Success depends on careful patient selection based on organ function recovery and optimal surgical timing, with ECMO serving as a crucial bridge. These findings underscore the need for standardized treatment protocols to maximize survival in this challenging patient population. Copyright © 2026 The Author(s); This is an open access article distributed under the terms of the Creative Commons Attribution License (CC-By-NC: https://creativecommons.org/licenses/by-nc/4.0/legalcode.en)