Henry Ford Health System on Monday announced that it performed what the health system believes is the first ever double-lung transplant for a patient with a vaping-related illness.
Background: Cases of a vaping-linked illness surpass 2,000
CDC data updated Thursday shows the number of reported cases of a lung illness officials believe is linked to e-cigarette use and vaping, dubbed EVALI, reached 2,051 as of Nov. 5, with 39 confirmed deaths. Cases of the illness have been reported in 49 states, Washington, D.C., and one U.S. territory, with deaths confirmed in 24 states and the District of Columbia. Alaska is the only state with no reported cases of the illness.
Doctors report that patients' recoveries have varied, with some patients appearing to make full recoveries and others continuing to have trouble breathing. CDC last month reported that some patients have relapsed and had to be hospitalized a second time, with readmissions occurring from as few as five days to as many as 55 days after initial discharge.
CDC said it is unclear why those patients relapsed. However, Anne Schuchat—CDC's principal deputy director, who oversees the agency's investigation into the matter—said it is possible that the lung illness made the patients more susceptible to other conditions. In addition, she said steroids used to treat the lung illness could "set [patients] up for increased infection risk."
CDC officials on Friday said they have identified vitamin E acetate as one potential cause of the illness, noting that the chemical was present in all samples of lung fluid collected from 29 patients who were hospitalized with the illness after vaping. The samples included lung fluid from some patients who had died from the illness.
Schuchat said the findings represent a "breakthrough" in CDC's investigation into the potential causes of the illness, but she noted that the findings do not rule out other compounds or ingredients as additional potential culprits. Further, Schuchat clarified that while vitamin E acetate appears to be associated with the lung illness, there is not yet enough evidence to definitively state the chemical is causing the illness.
Doctors perform first double-lung transplant related to vaping illness
Henry Ford Health System on Monday announced that doctors at the Detroit-based health system on Oct. 15 performed a double-lung transplant on a 17-year-old patient whose lungs were irrevocably damaged due to the vaping illness. The operation is "the first double-lung transplant in the world for a patient whose lungs were irreparably damaged from vaping," the health system said.
According to the New York Times, the patient on Sept. 6 was originally admitted to a different hospital for what providers believed was pneumonia. However, the patient's condition continued to worsen, requiring providers to place him on a ventilator on Sept. 12 and later, on Sept.17, to transfer him to a second hospital so he could be placed on a machine that fills the bloodstream with oxygen. Eventually, as the patient continued to deteriorate, providers on Oct. 3 transferred him to Henry Ford Hospital, where doctors placed him on the lung transplant waiting list.
Hassan Nemeh, who led the surgical team at Henry Ford, said the patient's lungs were scarred, rigid, inflamed, and marked with dead spots. According to the Times, the patient's lungs "were not visible" on a CT scan because they were not working and didn't contain air.
"What I saw in his lungs is like nothing I've seen before, and I've been doing lung transplants for 20 years," Nemeh said. "This is an evil I haven't faced before."
Nemeh said the patient's age and severe lung damage placed him at the top of the transplant list.
On Oct. 15, the doctors performed the double lung transplant. The patient is recovering well, but is still in the hospitals, the Times reports. Doctors noted that the patient will have to be immune system suppressing drugs for the rest of his life.
The patient requested privacy during his treatment, but asked the hospital to share his condition along with pictures about his injuries to "warn others" of the risks of e-cigarette use and vaping.
A statement from the patient's family read, "Within a very short period of time, our lives have been forever changed. He has gone from the typical life of a perfectly healthy 16-year-old athlete—attending high school, hanging out with friends, sailing and playing video games—to waking up intubated and with two new lungs, facing a long and painful recovery process as he struggles to regain his strength and mobility, which has been severely impacted."
David Christiani of the Harvard T.H. Chan School of Public Health and Massachusetts General Hospital, who was not involved in the transplant, said it is unclear whether more double-lung transplants will be performed on patients with the vaping-related illness as a result of Henry Ford Health System's announcement. He said the number of such transplants will depend on how many donor lungs are available and the extent to which the effects of the vaping-linked illness lead to other health conditions. However, Christiani said, "It would be nice if [the transplant reported by Henry Ford Health System is] the last—if the epidemic of acute lung injury can be brought under control."
Denitza Blagev, a pulmonologist at Intermountain Health Care, said many doctors have "certainly seen people who are very sick with" the vaping-related illness said, but she is "not aware (of any other double-lung transplants) and 100% certain none of the patients [at Intermountain] have had a lung transplant from e-cigarette or vaping-associated lung injury" (Williams, Associated Press, 11/11; Christensen, CNN, 11/11; Grady, New York Times, 11/12).