Fatal acute respiratory distress syndrome caused by donor-derived human metapneumovirus after lung transplantation.

Respiratory viral infections, including human metapneumovirus (hMPV), are increasingly recognized as a significant cause of morbidity and mortality in lung transplant recipients (LTRs). We present a case of hMPV pneumonia in a bilateral LTR, likely transmitted by the donor, resulting in severe acute respiratory distress syndrome and leading to death. Next-generation sequencing of hPMV genomes was performed from both the recipient's bronchoalveolar lavage and the organ conservation liquid and strongly supported the presence of donor-derived infection. There is still limited reported evidence to support systematic viral testing of donor respiratory specimens. This case highlights the need to better assess and control the risk of donor-derived respiratory viral infections in LTRs.