Need for dual lung transplants goes up in post-COVID patients in Chennai

Though they form only a small fraction of those who recovered from the infection, getting lungs for each patient, a difficult task even during normal times, has become even more difficult due to various challenges, doctors said. 

Though a majority of patients recover from COVID pneumonia, many develop secondary infections after that. Some of them suffer lung damage gradually and remain on oxygen. If the oxygen saturation in their blood drops even after ventilator support, they are put on Extracorporeal membrane oxygenation (ECMO). Those who suffer severe and irreversible damage are considered for double lung transplant, explained doctors. 

“ECMO support is given for 4-6 weeks, and if that doesn’t work, double lung transplant is the only way out. Even after the transplant, these patients are supposed to be on a lot of medications. They have about 50 per cent survival rate of up to five years,” said Dr Anantha Subramanian, pulmonologist, Kauvery Hospital. 

Those who suffered damages to other organs due to COVID are not considered for double lung transplant, he added. 

Getting a healthy lung for transplantation is another struggle that doctors face. Dr Suresh Rao, co-director, Heart and Lung Transplantation Programme - Mechanical Circulatory Support, MGM Healthcare, said the dual lung transplant was challenging because even after registering for the transplant, the hospital receives the organ after a month or even more by which time the condition of the patient would have worsened. 

“We used to get dual lung donations from the other cities. But that has become difficult after the lockdown. As only about 20-30 per cent of the brain dead cases we receive have healthy dual lungs for transplantation, availability is a major concern,” he explained. 

Doctors said there is an increase in post-COVID cases with higher intensity and more cases of fibrosis when pulmonary rehabilitation is not an option. 

“Those on immunosuppressive drugs, elderly persons suffering from chronic diabetes and those with other comorbidities can develop lung fibrosis. For them, the ECMO support is given as a bridge if they can benefit from lung transplant. The selection of candidates for dual lung transplant is also very difficult, as there can be secondary infections and their bodies may reject it after transplantation procedure. The pulmonary rehabilitation is also important after recovering from COVID to ensure that the lung condition does not worsen,” added Dr S Suresh, consultant pulmonologist, Gleneagles Global Health City.