Opinion: What you need to know about COVID-19 and lung transplants

Afshar is the medical director of the lung transplant program at UC San Diego Health and lives in Carmel Valley. Golts, MD, is the surgical director of the lung transplant program at UC San Diego Health and lives in Carmel Valley.

Lung transplantation is a medical and surgical procedure for some patients with end-stage lung disease who resist medical treatment. Many healthcare professionals are required to take care of any candidate for a lung transplant and then maintain guarantees of long-term survival with a superior quality of life. The SARS-CoV-2 pandemic has reminded society of how close patients are to death when their lives are compromised by severe lung damage. As the Medical and Surgical Directors of the Lung Transplant Program at UC San Diego, we felt compelled to share our perspectives on the challenges patients face when facing severe lung-related complications. COVID-19 virus. What patients are feeling is not a two-second television reel in intensive care.

About a third of pulmonary cases of COVID-19 are so severe that they warrant an ICU level of care. The diagnosis of acute respiratory distress syndrome can range from mild to severe. There is variability in patient care needs; some require a higher degree of supplemental oxygenation (without the need for intubation and mechanical ventilation). Up to 10 percent of these patients have a much more severe lung injury requiring weeks to months of mechanical ventilator assistance and, even if qualified, may additionally require extracorporeal membrane oxygenation ( ECMO).

ECMO is similar to a heart-lung bypass machine that delivers oxygen directly to the bloodstream through large cannulas located in the neck or groin. Together with our colleagues in intensive care, we regularly monitor the progress of these patients.

In scenarios where patients show no signs of recovery after four to six weeks of aggressive therapy, patients will undergo a lung transplant evaluation. Another scenario when we evaluated patients for lung transplantation includes extensive irreversible lung scarring as a result of damage (pulmonary fibrosis) due to COVID-19 infection.

Some patients are recovering from the acute phases of the lung injury from COVID-19. They are sent home or to a skilled nursing facility. These COVID-19 survivors are not entirely clear. More recent data shows that even among those survivors who have been discharged, there is an approximately 20% hospital readmission rate within 60 days. Nine percent of these readmitted patients died.

Nationally, only 30 to 40 percent of all lung transplant applications become eligible candidates for the lung transplant list. Common problems that prevent the remaining 60 to 70 percent from being a candidate for a lung transplant include obesity, severe malnutrition, active cancer, debilitation, uncontrolled diabetes, and uncontrollable infections, not to mention. name a few.

A significant number of applicants referred due to complications from COVID-19 (acute respiratory distress syndrome or pulmonary fibrosis) are ineligible due to high-risk issues. They include repeated infections of the bloodstream (bacterial and fungal), infections of the heart valves, severe malnutrition, blood clots, skin lesions, active and recurrent bleeding, muscle breakdown with severe physical limitations for not being able to swing only at the edge of the bed. It is not because of the lack of heroic efforts of the multitude of health professionals who help day and night: doctors, surgeons, pharmacists, nurses, respiratory therapists, physiotherapists and occupational therapists. Additionally, patients and their families may experience psychological burden such as severe anxiety and post-traumatic stress disorder. When faced with the choice of life or death, lung transplantation is an ideal treatment option.

Transplant recipients are living longer due to advances in surgical techniques, intensive and post-transplant care and medication protocols to minimize infections and episodes of rejection. This treatment is not for the faint of heart. It takes a lot of dedication. Once actively enrolled for a lung transplant, the patient will have to wait for an appropriate match based on lung size, need for one or both lungs, blood group, and immunologic profiles. It can take weeks or even months for some. Unfortunately, some do not survive until a viable donor lung is available. Routine follow-up for lung transplant recipients is extensive. In addition to recovering from surgeries, patients should take 20-25 tablets per day, perform daily exercises, monitor their blood pressure and blood sugar levels, undergo breath tests, undergo bronchoscopic airway inspections, and have visits. routine in the clinic.

The goal of our lung transplant program is to provide world-class care to those in dire need of a lung transplant. Most importantly, we assess whether there is a potential need and encourage patients when they improve and avoid the need for a lung transplant. In this case, we advocate primary prevention of lung disease through vaccination and respectful social distancing.

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