Case Report: Lung transplantation for rare anti-MDA5-positive rapidly progressive interstitial lung disease: two cases and a narrative review.

Lung transplantation is a definitive lifesaving option for end-stage lung disease; however, its role in rapidly progressive interstitial lung disease (RP-ILD) associated with anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibodies remains debated. We retrospectively analyzed two anti-MDA5-positive RP-ILD (MDA5+ RP-ILD) patients who underwent bilateral lung transplantation and synthesized pertinent literature to evaluate clinical value and the impact of therapeutic interventions. Both patients recovered postoperatively and were discharged after symptomatic management and supportive care. One patient subsequently developed cerebral infarction and died approximately 8 months after transplantation, whereas the other remains clinically stable under regular follow-up. Given the limited efficacy of conventional therapies and the overall poor prognosis of anti-MDA5-positive dermatomyositis (MDA5+ DM) with RP-ILD, our observations-together with prior reports-support lung transplantation, with extracorporeal membrane oxygenation (ECMO) as a bridge when necessary, as a promising and reliable therapeutic strategy. Lung transplantation may offer definitive treatment in carefully selected patients, underscoring its important clinical value.