Double-lung transplants increase after Covid ‘honeycombs’ organs
John Micklus’s battle with covid-19 began last christmas and ended five weeks later with lungs so damaged that doctors said there was nothing they could do to save him.
“The doctor’s recommendation was to get my affairs in order,” Micklus said. The 62-year-old called his wife from his hospital bed in southern Maryland. she, in turn, desperately called several physicians, and eventually learned of one last option: A double-lung transplant.
Micklus was transferred to the university of Maryland Medical center in Baltimore, where a rigorous assessment qualified him to receive lungs from a matched donor days later. he was discharged from the hospital on March 30, marking the center’s second successful lung transplant in a covid survivor.
hospitals across the us have reported a rise in lung transplants for severe coronavirus cases, the cleveland clinic, one of the country’s top-ranked medical centers, said last week. The grueling surgery may be the only solution for patients who experience a life-threatening constellation of lung damage inflicted by the virus, a hyper-inflammatory immune response to it, and the body’s failure to properly repair the injury.
‘Honeycomb change’
All of that can cause the deposition of yellow fibrotic scar tissue, creating a “honeycomb change” that makes the lungs completely solid, said David kleiner, who heads autopsy pathology in the national institutes of health clinical center in Bethesda, Maryland.
The process irreversibly destroys the tiny grape-like air sacs through which gas is exchanged in the lungs, kleiner said in a lecture on covid autopsies in July. “Patients really only survive to that fibrotic stage if they are intubated,” he said, adding that the harmful scarring can occur within a couple of weeks of lung injury.
such cases have led to lung transplants around the world, according to a study in The lancet Respiratory Medicine journal last month, highlighting yet another dimension of the pandemic’s burden on both survivors and health-care resources. The procedure can be done successfully in carefully selected patients, said the authors from the us, india, Austria and italy, who proposed criteria for selecting suitable covid patients.
in patients who can’t be weaned from a ventilator or an artificial lung that oxygenates blood, a donor organ may be the only life-saving option, according to doctors at chicago’s northwestern Memorial hospital, where the first double-lung transplant in a covid case in the us took place in June 2020. it’s done 18 more since, and has at least five patients waiting for donor organs, Ankit Bharat, the hospital’s chief of thoracic surgery and surgical director of lung transplantation, said in the Journal of the American Medical Association Thursday. “We are seeing a significant surge in patients who recovered from moderate to severe covid and are now coming to the outpatient setting with progressive oxygen requirements and pulmonary fibrosis,” Bharat said.
Complicated surgery
Writing in a study in science Translational Medicine in December, Bharat and colleagues described three patients—aged 28, 43 and 62—whose surgeries each took about 9.5 hours, required double the amount of blood normally infused during the procedure, and involved two weeks of post-operative intensive care. More than 107,000 people are waiting for a life-saving organ transplant in the us, according to the united network for organ sharing. Waiting lists for a full lung transplant, where the organ is provided by donors who have died, are often prohibitively long.
Bharat said he’s concerned covid may shrink the current pool of donor organs and affect their future availability. Almost 33 million people in the us have been diagnosed with the disease, he said, adding that there are reports that up to 80% of them, including many who were asymptomatic, may suffer lung injury.
“it remains to be seen whether or not other patients who have recovered from mild, moderate, or even severe covid-19 are going to be organ donors,” Bharat said. “if not, this may lead to a significant contraction of our donor pool.”