This story was published by the San Antonio Express-News on Nov. 24, 2020.
A patient who suffered permanent lung damage from COVID-19 is recovering after receiving a double lung transplant at University Hospital several weeks ago.
The surgery in late October was the first of its kind to be performed in San Antonio. Only a small number of the procedures have taken place in Texas.
Before the transplant, the University patient had required extracorporeal membrane oxygenation, a type of life support that bypasses the lungs by manually adding oxygen and removing carbon dioxide from the blood.
Doctors with University Transplant Center said the patient, who is from the South Texas region, has asked for privacy at this time.
Over the past few months, a handful of critically ill coronavirus patients from San Antonio have undergone lung transplants, but their procedures had all been performed elsewhere. Transplants are considered a last resort for patients who were largely healthy prior to their illness but show no signs of recovering from their lung injury.
In the most serious cases, COVID progresses to acute respiratory distress syndrome, where fluid accumulates in the air sacs of the lungs, impeding their ability to provide oxygen to the body. The organs can also suffer damage from the pressure of mechanical ventilation.
Nationally, only a small number of those patients have met the criteria for double lung transplants.
Candidates must have irreversible lung damage but be strong enough to participate in rehabilitation before the surgery, which has higher rates of infection and rejection than other types of transplants. Advanced age, serious underlying health conditions and damage to other organs — all common features of the sickest coronavirus patients — typically rule out patients from being considered for a transplant.
Dr. Edward Sako, surgical director of University’s lung transplant program and a professor of cardiothoracic surgery at UT Health San Antonio, said the staff had been bracing for a difficult surgery. Other transplant centers have reported a high level of scarring in COVID patients’ chests that complicated the process of removing their damaged lungs.
However, Sako said they didn’t encounter such scarring with this patient, making the procedure similar to other lung transplants the program performs.
What is significantly different for COVID patients is the shock of needing a major, life-changing surgery after a sudden illness, said Dr. Deborah Levine, medical director of University’s lung transplant program. Other patients who need lung transplants contend with that reality as their disease progressively worsens over time.
“You don’t have the kind of mindset that, ‘I know I need a lung transplant in two years or one year or even six months,’” said Levine, who also leads the hospital’s Pulmonary Hypertension Center. “These patients haven’t had that time yet to put that into perspective for their life and how it will affect their family.”
Levine expects that, in addition to critically sick COVID patients, the program will perform transplants for individuals who suffer longer-term effects from the disease. Some patients may recover enough to be released from the hospital but still require supplemental oxygen, affecting their quality of life.
“Their lifestyles are very hampered,” Sako said. “Having trouble breathing from minute to minute is just something you can’t get away from.”
Levine said the transplant center expects to receive more referrals for COVID transplants as more patients realize it’s an option that may be available to them. There’s also the prospect of more referrals for transplants from another wave of coronavirus infections that is currently sweeping the country and is expected to continue through the holidays.
“Numbers wise, in my heart I believe that, yes, we’ll see a lot more than we’ve seen in the summer,” she said.
Lauren Caruba covers health care and medicine in the San Antonio and Bexar County area.