The burden of lung transplants increases in the US due to COVID-19

John Micklus’ battle with COVID-19 began last Christmas and ended five weeks later with his lungs so damaged that doctors said there was nothing they could do to save him.

The burden of lung transplants increases in the US due to COVID-19

A 62-year-old man calls his wife from his hospital bed in the southern state of Maryland, USA. And in turn, she desperately called several doctors, only to find out one last option: Transplant both lungs.

Micklus was transferred to the University of Maryland Medical Center in Baltimore, where a rigorous evaluation confirmed his eligibility to receive a lung from a suitable donor a few days later. He was discharged from the hospital on March 30, marking the center’s second successful lung transplant for a COVID-19 survivor.

Last week, the Cleveland Clinic, one of the nation’s leading medical centers, said hospitals across the country were reporting an increase in lung transplants for patients with severe COVID-19. This type of surgery may be the only solution for patients who have experienced a series of life-threatening lung damage caused by a virus, caused by a super-inflammatory immune response to the virus, and whose body is not recovering properly. with damage.

“Honeycomb Lungs”

David Kleiner, physician in charge of pathology at the National Institutes of Health Clinical Center in Bethesda, Maryland (USA), said that post-COVID-19 lesions can cause the deposition of colored fibrous scar tissue. yellow, creating a “honeycomb transformation” that causes the lungs to completely solidify.

This process destroys the tiny air sacs through which gas is exchanged in the lungs, says Kleiner. “Patients only really survive to that stage of fibrosis if they’re intubated,” says Kleiner, adding that scarring can occur within weeks of lung injury.

Such cases have led to lung transplants around the world, inculcating another dimension of the pandemic burden on both those living and living, according to a study published in The Lancet Respiratory Medicine last month. and health care resources.

According to doctors at Northwestern Memorial Hospital in Chicago, the site of the first two-lung transplant for COVID-19 patients in the US in June 2020, with patients unable to leave ventilators or artificial lungs provided. oxygen for the blood, a donor lung may be the only life-saving option. This type of surgery has been performed in 18 more cases at the hospital since then and at least 5 patients are waiting for donated lungs.

Complicated surgery

The three patients – aged 28, 43 and 62 – underwent each operation that lasted about 9, said Dr. Ankit Bharat, chief of thoracic surgery and director of lung transplant surgery at Northwestern Memorial Hospital. At 5 hours, twice the normal amount of blood is needed to be transfused during surgery and weeks of intensive care after surgery.

According to the United Network for Organ Sharing, more than 107,000 people are waiting for a life-saving organ transplant in the US. The waiting list for a whole lung transplant is often very long.

Dr Bharat expressed concern that COVID-19 could narrow the current source of donated organs and affect future supply. 34 million people in the US have been diagnosed with COVID-19, and Mr Bharat said up to 80% of them, including many asymptomatic people, may have lung damage.

For COVID-19 patients in need of a lung transplant, timing is critical. If the surgery is performed too soon, there is a risk that the patient may not have recovered from the virus, said Robert Reed, associate medical director of the lung transplant program at the University of Maryland Medical Center. But doctors also “can’t do it too late, because by that point, the patient may be too weak to survive the surgery or meaningfully participate in the rehabilitation process.” power”.

In April, doctors in Japan performed the world’s first living donor lung transplant for a COVID patient. This person received lung segments from her son and husband. The surgery at Kyoto University Hospital took about 11 hours and involved 30 medical staff.

“We have demonstrated that we now have the option of lung transplantation from living donors,” said Hiroshi Date, a thoracic surgeon at Kyodo University Hospital who directed the surgery. know.

He said transplant surgery should not be seen as a way to speed up recovery from COVID-19. Lung recipients need to take more than a dozen drugs for the rest of their lives to prevent organ rejection and infection, and many of the drugs come with toxic side effects.