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June 12, 2020

Doctors perform the first known double-lung transplant on US Covid-19 patient

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    Doctors at Northwestern Medicine on Thursday announced they have successfully performed the first known double-lung transplant on a former Covid-19 patient in the United States, potentially paving the way for organ transplants to be used more frequently among patients with severe cases of the disease.

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    The worst lung damage this surgeon's ever seen

    The patient who received the transplant, whose name has been withheld, is a woman in her 20's who was healthy before she became infected with the new coronavirus. The woman was taking an immunosuppressant medication for a previous, minor illness when she contracted the virus, but it's unclear whether that medication made her more susceptible to the pathogen, the New York Times reports.

    The woman was ill for approximately two weeks before she was admitted to the hospital. According to Ankit Bharat—chief of thoracic surgery and surgical director for Northwestern's lung transplant program, who performed the operation—the new coronavirus severely damaged the patient's lungs.

    "They develop these strange holes in the lungs," Bharat said. "If you were to cut the lung, it kind of resembles a Swiss cheese."

    Bharat said the patient eventually developed secondary bacterial infections, but she couldn't be treated with antibiotics because of the extent of lung damage she'd experienced. And as her condition worsened, the patient's heart and other organs started to fail because of a lack of oxygen. Doctors placed the patient on a ventilator and, eventually, an extracorporeal membrane oxygenation device while they waited for her new coronavirus infection to clear.

    Once the patient tested negative for the new coronavirus, doctors performed a double-lung transplant. The surgery took 10 hours, which is longer than most lung transplant surgeries, because the inflammation the new coronavirus had caused in the patient's lungs left them "completely plastered to tissue around them, the heart, the chest wall, and diaphragm," Bharat said.

    Bharat added that the patient was the sickest person on whom he's ever performed a transplant—and the patient had the worst lung damage he's ever seen.

    "This is one of the toughest transplants I've done," Bharat said, though he noted that the transplant was the patient's only chance at survival. "You have someone in their 20s, who's otherwise healthy, this poor girl," Bharat said. "The whole team felt it's hard to let someone go like that. We wanted to give her every option. Everybody was just rooting for her."

    The patient is now breathing through a tube and is awake, eating, and able to communicate with her family, Bharat said. Her other organs also have healed, and while she will have a long rehabilitation, her prognosis is good, according to Bharat.

    What the transplant means for other Covid-19 patients

    Bharat said organ transplants may become more frequent to treat patients with severe cases of Covid-19. "I certainly expect some of these patients will have such severe lung injury that they will not be able to carry on without [a] transplant," he said. "This could serve as a lifesaving intervention."

    However, Bharat cautioned that transplants may not be right for every patient with the disease.

    "I want to emphasize that this is not for every Covid patient," he said. "We are talking about patients who are relatively young, very functional, with minimal to no comorbid conditions, with permanent lung damage who can't get off the ventilator" (Bernstein/Powers, Washington Post, 6/11; Grady, New York Times, 6/11).

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