A woman in her twenties, whose lungs had been “irreversibly” destroyed by COVID-19, received a double lung transplant in Chicago, according to the hospital that saved the patient on Thursday, June 11, 2020.
Large punctures in the lung
“Her lungs showed no signs of recovery, they had even started to develop terminal fibrosis,” Ankit Bharat, head of thoracic surgery at Northwestern Hospital in Chicago, told AFP. It is a thickening of the fibrous tissue around the alveoli that leads to respiratory arrest and even death. It is the first transplant of its kind in the United States, but not in the world because Chinese doctors performed a double transplant on a 60-year-old woman in March.
Previously healthy, the patient had to spend six weeks in intensive care after infection with Covid-19. There she was intubated with a ventilator and connected to a blood oxygenation machine called ECMO, which bypasses the heart and lungs to artificially oxygenate the blood. Large holes had formed in the left lung, clearing the way for a bacterial infection. Doctors are fascinated by these holes because they are so specific for COVID-19. In early June, the patient’s lungs showed irreversible damage. 48 hours later, doctors at Northwestern Memorial Hospital performed a double lung transplant. “For many days, she was the sickest person in COVID’s intensive care unit – and perhaps the sickest person in the entire hospital,” recalls Dr. Beth Malsin, a lung and intensive care specialist at Northwestern Memorial Hospital, in a press release.
A “very difficult” operation
The transplantation was only carried out after the patient tested negative for the coronavirus and her organs were functioning normally again to have a realistic chance of survival. With ECMO and the care provided, “the patient had enough time to eliminate the virus from her body so that she could be considered for transplantation,” Dr. Bharat added. “We often had to respond very quickly, day and night, to help her oxygenate and support the other organs so that she could support the transplant,” confirms Beth Malsin.
The operation on June 5, 2020, lasted 10 hours and was “very difficult” according to the surgeon because the inflammation of the disease had left the woman’s lungs “completely engulfed in the tissue around her, the heart, the chest wall, and the diaphragm,” Dr. Ankit Bharat told the New York Times. Normally, with the dozens of transplants he performs each year, the procedure takes about six hours. But the success shows that this type of transplantation is possible and safe, the doctor is pleased to say. “I very much hope that we can operate on more and more patients who are now trapped in artificial respirators because their lungs have been permanently destroyed,” says Ankit Bharat. The first double lung transplant was performed in Toronto in 1986 by G. Alexander Patterson, who trained Dr. Bharat, who originally came from India.
Several weeks of convalescence
The patient, who prefers to remain anonymous, is now conscious. According to Dr. Bharat of the New York Times, she is recovering well: “She is awake, she is smiling, she has talked to her family in vision dialogues.” However, she will remain intubated and on a respirator for several weeks, her chest muscles are too weak to breathe. “The fact that we were able to transplant this patient quickly and safely is a testament to the infrastructure and expertise of our clinical care and research teams,” said Dr. Rade Tomic, a Pulmonologist and medical director of the lung transplant program at Northwestern Memorial Hospital. “Although this young woman still has a long and potentially risky road to recovery, since she suffered from multi-organ dysfunction in the weeks leading up to her transplant, we expect her to make a full recovery.”
Such irreversible lung damage is extremely rare for someone of this age. “How does a healthy 20-year-old woman get to this point? We still have a lot to learn about COVID-19,” adds Pulmonologist Rade Tomic. The team hopes that patients who were infected with the coronavirus and suffered a permanent loss of respiratory function may one day benefit from a transplant as well.