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Fact Checked

Are Double Lung Transplants Another Way to Treat COVID?

COVID, the 2019 Novel Coronavirus, continues to spread across the United States like wildfire, with nearly 3 million positive cases since testing began with more than 128,000 lives lost. 

Some individuals with COVID are asymptomatic (i.e., no symptoms), and roughly eighty percent experience only mild symptoms such as loss of smell, sore throat and low-grade fever. 

One Yale physician states that eighty-five percent of his patients do not require hospitalization at all. The remainder has it much worse, experiencing shortness of breath, body aches, chest pain and confusion. Some experience permanent damage to their heart, kidneys, lungs, and brain.

Thankfully, a large number of COVID-positive individuals recover. However, despite being listed in the recovered column, many of these cases have long term complications as a result of their illness. 

Life After COVID

Individuals with mild illnesses may expect a correspondingly mild recovery, whereas those with more severe forms of COVID can expect a lengthier recovery process, with a continuation of some of their symptoms, such as shortness of breath, fatigue, and cough. 

In the worst courses of COVID, individuals might have developed pneumonia or experienced a “cytokine storm” in which their body unleashes a strong immune response. This can lead to damage and scarring to the lungs from which the body might not fully recover

What recourse do those indidvuals have to enable them to return to a normal life?

Lung Damage Calls for Drastic Measures

So far, nine COVID-positive people worldwide have received double lung transplants

The wife of late Broadway star Nick Cordero took to social media platforms advocating for her husband to receive the surgery. Even after the star was COVID-negative, she said his lungs looked “severely damaged,” like those of a 50-year smoker. The actor suffered mini-strokes and infections and ultimately passed away on July 6th.

In the case of one young woman in Chicago, a double lung transplant saved her life.

According to Northwestern Medicine, she spent six weeks on a ventilator and had to make use of an extracorporeal membrane oxygenation (ECMO) device to do the work of her heart and lungs. Prior to her being positive for COVID, she had no medical conditions.

By the time she was listed and approved for a transplant, her lungs were physically damaged beyond repair. 

According to Dr. Ankit Bharat, Chief of Thoracic Surgery and surgical director of the lung transplant program at Northwestern Medicine, the procedure was longer and more complicated than the average transplant because her lungs were “completely plastered to the tissue around them, the heart, the chest wall and diaphragm.” 

In South Korea, a woman underwent the surgery after being on ECMO for sixteen weeks. Her doctors said that the success rate for lung transplants in ECMO patients is 50%. Her surgery took eight hours and her lungs were rock hard when removed. 

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A Breath of Fresh Air?

The road to recovery after a double lung transplant is not necessarily a smooth one. The physical toll of the surgery can be significant, with recovery taking several months

Physical therapy and exercise will be important parts of a recovery regimen. Most individuals can slowly resume their regular physical activities, including running and other forms of cardio, but they should avoid contact sports and pressure changing activities like skydiving or scuba diving. 

Infection risk, medications, and physical therapy will all be normal fare for transplant recipients. For example, recipients can expect to take a significant number of medications for the rest of their lives. 

When someone receives an organ transplant, the body recognizes the donor tissue as an invader and responds accordingly by mounting an immune response. Medications called immunosuppressants can be used to stop this response. However, they come with their own range of side effects including: mood changes, insomnia, dizziness and weight gain.

These medications also end up making a person’s immune system weaker. As a result these patients are at high risk for bacterial and fungal infections, from themselves, the lung donor, and their environment. Therefore, transplant recipients may require antimicrobials to treat these infections. 

So, Who Gets a Transplant?

With only nine of these surgeries having been performed worldwide as of right now, it is still way too soon to declare definitively how practical a transplant is as a treatment for COVID. The procedure is risky, and the recovery is complicated. There is also no long term data yet on how individuals with COVID fare post-transplant. 

It is also important to remember that so far double lung transplants are primarily used after someone has already suffered through COVID and experienced permanent lung damage. For those, eighty percent of COVID-positive individuals, who experience mild illnesses, symptomatic treatment, and isolation are still the preferred treatment. Individuals with more severe cases should have an informed discussion with their healthcare providers and family as the standards of care continue to evolve.

References:

Cases in the U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/cases-in-us.html. Published July 4, 2020. Accessed July 10, 2020.

Cha S. South Korean COVID-19 patient recovering after double lung transplant. Reuters. https://www.reuters.com/article/us-health-coronavirus-southkorea-patient-idUSKBN248042. Published July 7, 2020. Accessed July 10, 2020.

Coronavirus Diagnosis: What Should I Expect? Coronavirus Diagnosis: What Should I Expect? | Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/diagnosed-with-covid-19-what-to-expect. Accessed July 10, 2020.

Grady D. Covid-19 Patient Gets Double Lung Transplant, Offering Hope for Others. The New York Times. http://www.nytimes.com/2020/06/11/health/coronavirus-lung-transplant.amp.html. Accessed July 10, 2020.

MacMillan C. What Does Recovery From COVID-19 Look Like? Yale Medicine. https://www.yalemedicine.org/stories/covid-19-recovery/. Published June 19, 2020. Accessed July 10, 2020.

Martin A. Nick Cordero needs double lung transplant to live best life, says wife. UPI. https://www.upi.com/Entertainment_News/2020/07/02/Nick-Cordero-needs-double-lung-transplant-to-live-best-life-says-wife/2371593704631/. Published July 2, 2020. Accessed July 10, 2020.

NHS Choices. https://www.nhs.uk/conditions/lung-transplant/recovery/. Accessed July 10, 2020.

Northwestern Medicine. Lung Transplant Performed on a COVID-19 Patient at Northwestern Medicine. Northwestern Medicine. https://www.nm.org/about-us/northwestern-medicine-newsroom/press-releases/2020/lung-transplant-performed-on-covid-19-patient-at-northwestern-medicine. Accessed July 10, 2020.

Nosotti M, Tarsia P, Morlacchi LC. Infections after lung transplantation. Journal of thoracic disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6051843/. Published June 2018. Accessed July 10, 2020.

Post-Transplant Recovery. Post-Transplant Recovery | Columbia University Department of Surgery. https://columbiasurgery.org/lung-transplant/post-transplant-recovery. Accessed July 10, 2020.

Recovering From Coronavirus: What to Expect During and After Your Recovery. Houston Methodist On Health. https://www.houstonmethodist.org/blog/articles/2020/apr/recovering-from-coronavirus-what-to-expect-during-and-after-your-recovery/. Accessed July 10, 2020.

What Coronavirus Does to the Lungs. What Coronavirus Does to the Lungs | Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/conditions-and-diseases/coronavirus/what-coronavirus-does-to-the-lungs. Published April 13, 2020. Accessed July 10, 2020.

Wickerson L, Rozenberg D, Janaudis-Ferreira T, et al. Physical rehabilitation for lung transplant candidates and recipients: An evidence-informed clinical approach. World journal of transplantation. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5036121/. Published September 24, 2016. Accessed July 10, 2020.

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Published July 21st, 2020 by Dr. Brady McNulty, PharmD, BCGP
Fact Checked by Chris Riley

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