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Double lung transplantation increases after Covid-19 infection causes “honeycomb changes”




The fight between John Mikurus and Covid-19 began last Christmas and ended five weeks later with a damaged lung, doctors said there was nothing he could do to save him.

“The doctor’s recommendation was to organize my work,” Mikurus said. The 62-year-old called his wife from a hospital bed in southern Maryland. She then desperately called several doctors to finally find out about her last option, a double lung transplant.

Mikurus was transferred to the University of Maryland Medical Center in Baltimore, where rigorous evaluation qualified him to receive lungs from a matching donor a few days later. He was discharged on March 30 and recorded a successful second lung transplant at the center in Covid survivors.

Hospitals across the United States have reported an increase in lung transplants for severe coronavirus cases, the Cleveland Clinic, one of the country’s top-ranked medical centers, said last week. Severe surgery may be the only solution for patients who experience a series of life-threatening lung injuries caused by the virus, a hyperinflammatory immune response to it, and the body’s inability to properly repair the injuries. There is.

“Honeycomb change”

David Kleiner, head of autopsy pathology at the National Institutes of Health Clinical Center in Bethesda, Maryland, said all of this could cause the deposition of yellow fibrous scar tissue, causing a “honeycomb change” that completely solidifies the lungs. He said he had sex.

This process irreversibly destroys the small vine-like air sacs that exchange gas in the lungs, Kleiner said in a July talk on Covid autopsy. “Patients can only survive to that stage of fibrosis if they are intubated,” he added, adding that harmful scarring can occur within a few weeks of lung injury.

A study by The Lancet Respiratory Medicine Journal last month found that such cases led to lung transplants worldwide, highlighting yet another aspect of the pandemic burden on both survivors and medical resources.

Why the influence of “Long Covid” lasts longer than a pandemic

The authors of the United States, India, Austria, and Italy, who proposed criteria for selecting appropriate Covid patients, said that this procedure could be successfully performed in carefully selected patients.

Donor organs are the only life-saving option for patients who are unable to leave the ventilator or blood oxygenator, according to doctors at the Northwest Memorial Hospital in Chicago, where the first double lung transplant was performed at Covid. There is a possibility. The case in the United States occurred in June 2020. More than 18 times since then, at least five patients are waiting for donor organs, Ankit Bharat, director of chest surgery and lung transplant surgery at the hospital, said in the Journal of the American. Thursday’s medical association.

“There is a significant surge in patients who have recovered from moderate to severe Covid and are now in the outpatient setting with progressive oxygen demand and pulmonary fibrosis,” said Bharat. ..

Complex surgery

In a December Science Translational Medicine study, Bharat et al. Described three patients aged 28, 43, and 62 years. Each of these patients took about 9.5 hours to operate, requiring twice the amount of blood normally injected during the operation and involved two people. Weeks of postoperative intensive care.

According to the United Network for Organ Sharing, more than 107,000 people in the United States are waiting for a life-saving organ transplant. The waiting list for a complete lung transplant provided by a donor whose organ has died is often exorbitant.

Mr. Bharat said he was concerned that Covid could shrink the current pool of donor organs and affect future availability. About 33 million people have been diagnosed with the disease in the United States, and there are reports that up to 80%, including asymptomatic people, may have lung damage, he said.

“It is not yet known if other patients who have recovered from mild, moderate or even severe Covid-19 will become organ donors,” Bharat said. “If not, this could lead to a significant reduction in our donor pool.”

Important timing

Timing is important for Covid patients who need a lung transplant. Robert Reed, associate medical director of the University of Maryland Medical Center’s lung transplant program and helped with the care of Mikurus, said patients were at risk of not being able to get rid of the coronavirus infection if these treatments were taken too early.

“It can’t be too late, because at that point the patient may be very weak, unable to survive surgery and meaningfully participate in rehabilitation,” Reed said.

In April, Japanese doctors reported the world’s first “living donor” transplant to a Covid patient who received a lung area from his son and husband. The surgery at Kyoto University Hospital took about 11 hours with a team of 30 medical personnel.

Hiroshi Date, a thoracic surgeon at the hospital who led the surgery, told reporters that he “showed that he had the option of a lung transplant” from a living donor.

Reed, a professor of lung and emergency medicine at the University of Maryland, said transplant surgery should not be seen as a way to speed recovery after Covid. Lung recipients need to take more than 12 medications throughout their lives to prevent organ rejection and infections, and many have toxic side effects.

“It’s better to rehabilitate slowly for a long time and have your lungs there, rather than having a transplant,” Reed said in an interview with Zoom. “But that’s amazing for people who are more likely to die within two years, or who are essentially lung-impaired.”

Micklus wants to let others know that lung transplants can give hope to others suffering from end-stage lung damage caused by Covid-19. “It’s difficult,” he said with tears. “It’s physically and emotionally exhausting, but it’s an opportunity to live again.”

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