Double-lung transplant on COVID-19 patient offers hope for others

A woman in her 20s has become the first person in the United States to receive a double-lung transplant for COVID-19, offering hope for other critically-ill coronavirus patients, her doctor said Thursday.

She had spent six weeks in the intensive care unit of Northwestern Memorial Hospital in Chicago, where a life support machine performed the work of her heart and lungs, keeping her alive.

But by early June her lungs had become so badly damaged that a transplant was her only hope.

"Her lungs just showed no signs of recovery, in fact they had started to develop terminal fibrosis," Ankit Bharat, chief of thoracic surgery at the Northwestern Medicine Lung Transplant Program told AFP.

Fibrosis is the permanent scarring of the lung tissue, which in turn leads to destruction of the air sacs.

She had also developed large holes in her left lung, leaving it festering with a dangerous bacterial infection.

These cavities are thought to be unique to the COVID-19 illness and have left doctors mystified.

Bharat, 40, has performed dozens of lung transplants, but said this operation on June 5 was "very difficult," requiring 10 hours rather than the six it normally takes.

This was partly because the lungs had become stuck to the surrounding structures and were difficult to remove.

Bharat added the procedure's success led him to "absolutely think and hope that we can operate on many more patients who are now stuck on the ventilator because their lungs have been permanently destroyed."

FaceTiming with family

The patient, who is Hispanic, is now conscious and has been FaceTiming with members of her family, added Bharat.

She remains on a ventilator and is breathing via an opening in the throat called a tracheostomy, as she gathers her strength before she can be discharged in a few weeks.

It is the first time a double-lung transplant for a COVID-19 patient has taken place in the US.

China announced a similar operation on a 66-year-old woman in March.

The world's first double-lung transplant was performed in Toronto in 1986.

It was led by G. Alexander Patterson, under whom Bharat, who is originally from India, was trained.

Before the US patient could receive the transplant, she had to test negative for the SARS-CoV-2 virus that causes COVID-19.

"For many days, she was the sickest person in the COVID ICU -- and possibly the entire hospital," said Beth Malsin, a critical care doctor.

"There were so many times, day and night, our team had to react quickly to help her oxygenation and support her other organs to make sure they were healthy enough to support a transplant."

It is very unusual for a young woman to have suffered such extensive lung damage from the coronavirus, and doctors hope to study her closely to learn more about why this happened.

Though generally healthy, she had a minor illness requiring medication that suppressed her immune system to some extent, but it was not clear that this was the cause of the extreme lung damage.

Donor shortages

Beyond proving that other critically-ill COVID-19 patients can be saved, lung transplants could also help patients who are well enough to return home, but who might go on to suffer a permanent loss of breathing function, added Bharat.

As with other organs, there is a shortage of donors, and wait times in the US are three to six months.

Bharat said less than 15 percent of all lungs that are offered are deemed suitable for use, but new techniques including "ex vivo lung perfusion" are increasingly being used to repair some of those organs.

"Necessity drives innovation, so I think, if more patients need transplants you will figure out a way," he said.