The Vall d’Hebron Hospital (Barcelona) has performed a transplant of both lungs to Jordi, a 51-year-old man who had them “destroyed” after having suffered a “severe” covid-19. This is the first case in Spain of a lung transplant in a post-covid patient. In other words: a “historical fact” in this pandemic and in Spanish and Catalan health, as defined by the doctors themselves.
Jordi was infected at the beginning of the year, in the third wave of coronavirus, and had been in the ICU of Bellvitge Hospital (L’Hospitalet) for 122 days . The inflammation caused by the coronavirus had caused irreversible damage to the lungs.
He did not have any significant previous pathology before catching the coronavirus. After a “complicated” operation that lasted “nine hours”, he is now admitted to a plant in Vall d’Hebron, he can breathe on his own and in a week the doctors will discharge him.
“His lungs are not working little, it is that they no longer worked at all. He had been with Ecmo support for four months,” explained Maribel Rochera, from the Anesthesiology Service, at a press conference this Friday , who has defined the intervention as “a a new door that opens “in the treatment of covid-19.
“It has been a historic challenge and could only be the product of multidisciplinary work”, highlighted Carles Bravo, coordinator of the Vall d’Hebron Pulmonary Transplantation Program for Pneumology.
Lung transplantation due to covid-19 is a type of intervention that is carried out in the world “from the beginning” of the pandemic, as explained by the Chief of Thoracic Surgery and Pulmonary Transplantation of Vall d’Hebron, Alberto Jauregui.
The one that was presented this Friday at the Barcelona hospital is the first case in Spain, not the first in the world. The United States is the country that performs the most transplants in post-covid patients.
According to Jauregui, there are two types of covid patients who are candidates to receive a lung transplant: “Those admitted to an ICU with severe pneumonia and those who, without being in an ICU, have sequelae from the COVID-19 that have probably caused them injuries in the lung”.
The story of Jordi, the 51-year-old postcovid patient transplanted in Vall d’Hebron, began at the beginning of the year with a “very serious infection” due to the coronavirus. The evolution of the disease was “very fast” and immediately the man, who first entered a regional hospital, needed to go to the Bellvitge ICU (a larger center), where he was connected to a ventilator and later to an Ecmo machine. .
“After four months in the ICU, the Bellvitge Hospital asked us for an assessment to see if we could transplant him. We put him on the preferential list for transplantation. It was a particularly complicated surgery that lasted nine hours and that went really well,” he said. related Jauregui.
A few days later, Jordi had his Ecmo support removed and a few days later he stopped using supplemental oxygen. “Now we have him on the floor and he breathes by himself. But he still has to do rehabilitation. In a week he will be able to go home,” he added. With the Vall d’Hebron early physiotherapy program, she began cycling in the same ICU 12 days after the intervention.
Dr. Jauregui, who has been involved in lung transplantation for more than 15 years, has pointed out that he had never seen “lungs like this”. “The color, the structure, the function … were totally deteriorated.” “They were much more inflamed lungs in relation to those found in other surgeries, and they recalled a mixture of different pathologies, from lungs suffering from fibrosis to others who come to the operating room after repeated infections and with thickened pleura “, has described the surgeon Leire Sánchez.
Transplantation, the only option
The double lung transplant was the only option to save Jordi’s life. “There were no more possibilities,” said Judith Sacanell, an ICU leader in Pulmonary Transplantation. “The rest of the organs worked perfectly. The patient had no other option, nor possibilities of leaving the Ecmo”.
The Ecmo, as explained by Jordi Riera, head of the Vall d’Hebron Ecmo Adult Program, is a “machine that connects to the patient through two arteries”. “It serves to remove the blood and give it back oxygenated. We use it when the heart or lungs do not work. It is a very complex technique. Ecmo allows the lung to rest,” he explained.
The patient lived connected to a machine and had “no more possibilities”
Since the start of the pandemic, Vall d’Hebron has supported 75 patients with covid-19 with this machine, of which 70% are already at home. The Ecmo applies to patients of a “not advanced” age and also “who do not have dysfunction of other organs”. “Jordi’s lungs were destroyed. We considered that there was no solution,” said Riera.
The intervention was complex because the doctors “had no previous experience” in transplanting a patient who had Ecmo support “so long in time”, has specified the anesthesiologist Rochera.
To date, health workers do not know how many postcovid patients may need a lung transplant. “We know that the majority of Ecmo patients have evolved well,” Rochera replied to questions from journalists. “But we will see if, a posteriori, they will or will not be from the group of patients who will end up needing a lung transplant.”
What doctors do know is that Jordi’s lung transplant “opens a door, until now closed” for other postcovid patients. Of course, “they must be very well selected patients.” “Because transplantation is always the last resort,” concluded the anesthesiologist.