Last summer, Northwestern Medicine surgeons performed lifesaving double-lung transplants on two patients whose lungs were severely damaged by COVID-19, offering a potential path to recovery from the devastating effects of the virus.
“We are one of the first health systems to successfully perform a lung transplant on a patient recovering from COVID-19,” says Ankit Bharat, chief of thoracic surgery and surgical director of the Northwestern Medicine Lung Transplant Program and associate professor of surgery and medicine at the Feinberg School of Medicine. “We want other transplant centers 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.”
The first patient, 28-year-old Mayra Ramirez, spent six weeks in the COVID ICU on a ventilator and extracorporeal membrane oxygenation (ECMO), a life support machine that does the work of the heart and lungs. While her body cleared the virus, her lungs were damaged beyond repair.
“For many days, she was the sickest person in the COVID ICU — and possibly the entire hospital,” explains Beth Malsin ’19 GME, a pulmonary and critical care specialist at Northwestern Memorial Hospital and an instructor of medicine at Feinberg. “There were so many times our team had to react quickly to help her oxygenation and support her other organs to make sure they were healthy enough to support a transplant if and when the opportunity came. One of the most exciting times was when the first coronavirus test came back negative and we had the first sign she may have cleared the virus to become eligible for a lifesaving transplant.
The lung transplant team listed Ramirez for the transplant, and 48 hours later, she became the first known COVID-19 patient in the United States to receive a double-lung transplant.
The second patient, Brian Kuhns, an Illinois man in his 60s, spent 100 days on ECMO. He received the majority of his treatment at another health system before being transferred to Northwestern.
“Prior to his arrival at Northwestern Memorial, the patient developed an invasive infection that required a major chest surgery. This was going to make the double-lung transplant substantially more difficult,” says Northwestern Medicine thoracic surgeon and Feinberg associate professor of surgery and medicine Samuel Kim, who assisted in the double-lung transplant alongside Bharat. “His lung damage was among the worst I’ve ever seen. When we opened the chest cavity there was a lot of evidence of infection; everything we touched or dissected started bleeding, and one misstep could have led to catastrophic consequences.”
Typically, a double-lung transplant takes six to seven hours, but this surgery took about 10 hours due to lung necrosis and severe inflammation. Bharat’s team is optimistic that both patients will make a full recovery. The surgeons are now offering guidance to other transplant centers. By mid-November, Northwestern surgeons had performed double-lung transplants on eight COVID-19 survivors.