First Double-Lung Transplant Performed After Irreparable COVID-19 Respiratory Damage

The 61-year-old patient suffered severe post-COVID-19 respiratory failure after three months on an oxygenated artificial lung and multiple treatment-related complications.

Doctors in Lisbon report on the case of a 61-year-old man who received a double lung transplant after his lungs were irreparably damaged by COVID-19, in a case presented at Euroanesthesia, the annual meeting of the European Society of Anaesthesiology and Intensive Care (ESAIC). ), held online this year on December 17-19.

The patient contracted COVID-19 in January 2021 and was discharged from the hospital on August 23, marking the Centro Hospitalar Universitário Lisboa Central’s first successful lung transplant in a COVID-19 survivor.

The man, who had a history of dyslipidemia (unusually high levels of cholesterol and other fats in the blood) and gastritis (inflammation of the stomach lining), was admitted to the emergency department on January 12, 2021 with a SARS-CoV-2 infection. pneumonia. .

Despite being supported on a ventilator, he deteriorated with severe shortness of breath due to low oxygen levels and required the advanced lung supportive therapy, extracorporeal membrane oxygenation (ECMO), which completely takes over the function of the lungs. He spent 74 days on ECMO before switching to extracorporeal carbon dioxide removal (ECCO2R) — a device designed to remove carbon dioxide, but not delivering such high levels of oxygen.

During those three months, he developed multiple infections, including pneumonia and prostatitis (swelling of the prostate gland), as well as blood complications, including a blood clotting disorder (ECMO-associated coagulopathy) and a life-threatening reaction to the blood-thinning medication heparin (heparin-induced thrombocytopenia).

“About 75% of the patient’s lungs had scars from COVID-19, and it was clear from his scans that his lungs were permanently damaged and would not recover,” said anesthesiologist Dr. Carolina Almeida of Centro Hospitalar Universitário Lisboa Central, who was part of the team that performed the transplant. “The patient was eligible for a transplant because he was young and strong enough to survive the risky procedures, and there were no other organs affected by COVID-19. After careful clinical evaluation, he received the life-saving organs in May.”

The surgery lasted approximately seven hours and involved two weeks of postoperative intensive care.

Restore trip

It has been six months since the transplant and his recovery is far from complete. His lung function is good and he no longer needs oxygen support during the day, but he has had to overcome numerous challenges along the way, including atrial fibrillation (irregular heart rhythm), a collapsed lung, subcutaneous emphysema (where air gets trapped under the skin), type 2 diabetes and various infections.

He continues to receive rehabilitation to improve his mobility, lung function and quality of life, and will have to take more than a dozen drugs for the rest of his life to prevent organ rejection and infections.

“The team is extremely grateful that the surgery went so well and that the patient came home to continue rehabilitation close to his family,” said Dr. Lurdes Castro, a senior anesthetist from Centro Hospitalar Universitário Lisboa Central who helped perform the transplant. “It takes tremendous willpower to overcome everything he’s been through, and it’s great to have played a part in giving this patient the chance to live again and return to his family and past life.”

The first small case series of early results after lung transplantation for severe COVID-19 was published in May 2021. “Lung transplant is a life-saving treatment for a carefully selected group of COVID-19 patients whose lungs have been damaged beyond repair by the virus and who are strong enough to undergo major transplant surgery,” said Dr Almeida. “But given the global impact of COVID-19 and the increasing number of younger, healthier patients being affected, the number of transplant candidates is likely to increase significantly. That number could grow to COVID-19 survivors whose lungs may deteriorate over time.”