A Texas man in his 50s beat COVID-19, but the virus took a severe toll on his lungs. In order to survive, doctors at the University of Florida determined he would need a double-lung transplant.
The patient, whose identity has not been released for his and his family’s privacy, became the third COVID-19 survivor ever to undergo the complicated procedure, and the first in Florida and the Southeast, said Dr. Tiago Machuca, the surgical director of the lung transplant program at UF Health. The other two patients to survive the coronavirus and receive double-lung transplants were treated at Northwestern Memorial Hospital in Chicago.
“These patients are heavily dependent on devices to keep them alive, but they don’t have the virus anymore,” Machuca said. “They don’t have any other organ dysfunction, and yet they’re left with no other options.”
A double-lung transplant is rare, and not normally recommended or used as routine therapy for the coronavirus, Machuca said. It is a complex surgery that requires a lengthy recovery period, and often major and permanent lifestyle changes after surgery. Machuca said transplants for coronavirus patients should be evaluated on a case-by-case basis, but he believes there will be more people who are likely candidates for this type of procedure during the pandemic.
“We’re not talking about an elderly patient,” or someone with pre-existing medical issues, Machuca said. “Our patient was in his 50s.”
The man tested positive for COVID-19 in April in his home state of Texas. Even though he recovered, the virus’ progression severely damaged his lungs. He was transported to Florida to await a transplant. The man was treated at UF Health Shands Hospital in Gainesville, where he relied on extracorporeal membrane oxygenation to breathe. The ECMO machine, a form of life support, acted as an artificial lung.
If the patient were to come off the ECMO machine, his risk of complication from infection or bleeding was high and there was little chance he would survive. These expensive machines are only found in hospitals.
It became clear to physicians that the patient’s lung damage was permanent. A lung transplant was the only option for recovery.
“This was someone who had survived a terrible virus but at a high cost to his body,” said Dr. Abbas Shahmohammadi, an assistant professor of medicine in the UF College of Medicine and a lung transplant specialist, in a statement. “We witnessed the way in which the virus had completely destroyed his lungs, and while his frailty was initially significant, we saw how determined he was and knew he could benefit from lung transplantation as we watched him become less frail over time.”
The Florida patient underwent physical therapy to help him recover some strength before and after the surgery, said Tony Garcia, a staff occupational therapist at UF Health. Garcia said on the first day of therapy, the man could barely stand or sit in a chair on his own. But during six weeks of physical therapy before and after the surgery, he was able to walk down the hall and putt a golf ball.
Only 20 percent of lungs from multi-organ donors are used in transplant procedures. Lungs are prone to being damaged during other kinds of medical treatment, which can make them unsuitable for donation, Machuca said. This limited access to viable organs means the waiting period for patients in need can be long.
After 33 days in the hospital in Gainesville and more than three months on the ECMO machine, donor lungs finally became available. A week after surgery, and the patient could breathe on his own without additional oxygen.
The patient will remain in Florida to recover under physician care for a few more weeks, but he is expected to make a full recovery.
“We’re talking about patients that have end-stage lung disease, they are in the ICU dying, having a second chance,” Machuca said.
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