Sunday, September 27, 2020

Doctors in Hyderabad perform India’s first double lung transplant on recovered Covid patient

Transplant News Sharing // News from Source theprint.in

Representational image | Flickr
Representational image | Flickr

New Delhi: In a first-of-its-kind procedure in the country, doctors in Hyderabad claimed to have successfully completed a double lung transplant on a recovered Covid patient. 

Rizwan, a 32-year-old patient from Chandigarh, underwent the transplant on 24 August at the Krishna Institute of Medical Sciences (KIMS) in Hyderabad, after matching with a deceased donor from Kolkata.

He was suffering from pulmonary sarcoidosis, a rare disease that leads to the formation of small lumps of inflammatory cells called granulomas in the lungs. In most cases, these granulomas heal and disappear on their own but in some cases they remain inflamed and stiffen, which is called pulmonary fibrosis.

This changes the structure of the lungs and manifests through physical symptoms like shortness of breath, wheezing, coughing and chest pain.

According to Dr Sandeep Attawar, the surgeon who performed the transplant, the patient had been waiting for the surgery for about six months.

“He had moved to Chennai while he was on the waitlist and three months back when the hospital’s operations moved to Hyderabad, he shifted too. It was during this travel that he contracted SARS-CoV-2,” Attawar told ThePrint.

“Due to his pre-existing lung condition, the state of his lungs worsened. From his previous requirement of 15-20 litres of oxygen per minute, post-Covid, he required 40-50 litres of oxygen to sustain,” he added.

The doctors found a donor match in Kolkata two weeks ago, and the organ was immediately flown to Hyderabad for the transplant.

“Finding a lung match is more difficult than other organs,” said Attawar, the head of thoracic organ transplants at KIMS Hospital.

Since the patient was Covid-positive, the doctors noted that preoperative care was essential for him. They waited for eight weeks to allow him to recover from the infection and test negative.

“Operating on a Covid positive not only increases exposure of the operating staff but is also life threatening for the patient,” Attawar said.

The doctors at KIMS also said the operation was “complex” and there was “no scope for errors”.

The patient has now been discharged, but he needs to stay in a bio-bubble environment — a secure environment that is sealed off from the outside world to minimise risk of infection. He will also need to be closely monitored for the next six weeks, including careful drug control.

Instances of lung transplants in recovered Covid patients

The incidence of lung transplants in Covid patients are few because of the risk factor and the acute shortage of healthy lungs.

Covid-19 is a respiratory disease that can cause severe damage to the lungs, starting with pneumonia, where the lungs get inflamed and filled with fluid. Breathing difficulty is typically experienced when pneumonia begins, and as it progresses, it could become Acute Respiratory Distress Syndrome (ARDS), a form of lung failure.

The first-ever documented case of a lung transplant on a recovered Covid patient was performed in Austria on 26 May. The 45-year old woman’s lungs had been damaged by a severe form of the infection.

A double lung transplant was performed in June in the US’ Chicago by Indian-origin surgeon Dr Ankit Bharat.

Speaking to the media, Bharat had said, “We want other transplant centres to know that while the transplant procedure in these patients is quite technically challenging, it can be done safely, and it offers the terminally ill Covid-19 patients another option for survival.”

In India too, Chennai-based Mahatma Gandhi Medical Healthcare performed a similar transplant on a 48-year old businessman from Gurugram on 27 August.

However, KIMS claims to have conducted the transplant on 24 August, which is three days before MGM Healthcare.

Why lung transplants are rare

According to Dr Attawar, it is difficult to find healthy lungs for transplants.

“In cases of death by road accidents patients may suffer from chemical pneumonia rendering the lungs unfit for donation. While in other patients who survive, post accident attempts of revival and treatment which include putting them on a ventilator can also make their lungs unfit for donation,” Attawar told ThePrint.

Chemical pneumonia occurs mostly in victims of road accidents when the chemicals from stomach reach the lungs and cause ‘chemical aspiration’. The inflammation comes from the toxic effect of stomach acid and enzymes on lung tissue.

“In essence, less than 20 per cent of potential lung donors can be considered for a transplant due to so many complications,” he added.

Sunayna Singh, who runs a Delhi-based NGO called Organ India that works on spreading organ donation awareness, said these surgeries are also very rare and expensive.

“The number of patients seeking lung donations are not as many as kidneys and eyes. These operations were rare and expensive, with innovation and technology we have seen more patients seeking lung transplants only in the last two years,” she said.

A research by doctors at Department of Heart and Lung Transplantation, Apollo Hospitals, Chennai, observed that by the time lung patients in India opt for a transplant, in most cases, it is too late.

The study explains, “In some instances, religious beliefs regarding organ transplantation may deter acceptance to transplant operation even when they are ‘fit’ for a transplant. The inevitable clinical deterioration ‘forces’ them to agree eventually, by which time they are bed bound with muscle wasting and result in stormy postoperative courses and lesser surgical outcomes.”

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